Healthcare Contracting Specialist

Provider Network Solutions LLC; Sarasota (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

Provider Network Solutions LLC is seeking a seasoned professional to manage physician contracting and statewide network development in Florida. You will develop, execute, and maintain a provider network strategy in collaboration with medical management and the Provider Servicing Department to meet growth and medical cost targets.

You will negotiate contracts, lead research on network needs, and grow the network by engaging physician personnel and ensuring credentialing requirements are met.

Qualifications

• Bachelor's degree or equivalent experience in network development or provider relations.
• Minimum three years' Medicaid/Medicare experience preferred.
• Healthcare/provider office or HMO/PPO background preferred.
• Strong knowledge of regulatory requirements concerning Medicare and Medicaid.

Responsibilities

• Negotiate and execute provider contracts.
• Lead research for institutions, networks, and ancillary needs using available tools.
• Develop provider networks for initial development or expansion per company goals.
• Explain protocol to physician personnel, including requirements to comply with standards.
• Collect credentialing packets per health plans and credentialing checklist during contracting.
• Ensure provider network includes Board Certified/Board Eligible specialists and/or ancillary providers.
• Manage physician network relationships to drive business results in the assigned region.
• Liaise with Contracting and Credentialing Coordinator for new contracting inquiries.
• Obtain leads for prospective physicians and follow up on contract status.
• Strategize to close quarterly Geo Access deficiencies per specialty and health plan.
• Handle special projects as assigned or directed.
• Negotiate and execute hospital contracts.
• Maintain and update CRM (Monday.com) to reflect progress of ongoing leads.

Skills

Negotiation

Communication

Problem-solving

Relationship-building

Bilingual

Education

Bachelor's degree or related field, or equivalent experience

Tools

MS Word

Excel

Outlook

PowerPoint

Job description

Description

Position Summary

Manages physician contracting and network development functions for developing, executing and maintaining a provider network strategy statewide. Works in concert with medical management and the Provider Servicing Department in developing actions to meet market growth and medical cost targets.

Duties and Responsibilities

• Primary duty of negotiating and executing provider contracts.
• Leads research for any Institution, Network and/or Ancillary needs using all tools available; including but not limited to: WebMD, Health Plan websites, hospitals, google, etc.
• Provider networks contracting for initial network development and/or expansion in accordance with Company goals and standards.
• Meet with the appropriate physician personnel and fully explain the Company’s protocol, which includes all requirements necessary to comply with standards identified in the Provider Manual.
• Collects complete credentialing packets per specified health plan and according to the Networks Credentialing checklist from network physicians during the contracting process.
• Ensures that the provider network consists of Board Certified/Board Eligible Specialists and/or Ancillary providers as contracted by the network.
• Manages physician network by developing relationships to drive business results within assigned geographic area.
• Liaison in conjunction with Contracting and Credentialing Coordinator, for all health plans on all new contracting inquiries.
• Obtains leads for prospective physicians, manages all incoming new provider leads and follows-up with the providers on the status of their new contractual agreement per the Department’s Policies and Procedures.
• Strategizes to close all quarterly assigned Geo Access deficiencies per specialty and health plan.
• Special projects as assigned or directed.
• Negotiating and executing hospital contracts.
• Maintaining and updating current CRM platform (Monday.com) to reflect progress of ongoing leads negotiations.

Requirements

Travel

Yes, 95% of the time or as otherwise required by the company throughout the following Regions:

• Region 6: Hardee, Highlands, Hillsborough, Manatee and Polk
• Region 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota

Knowledge

• A bachelor’s degree in a related field or equivalent experience related Network Development or Provider Relations experience.
• Minimum three (3) years’ experience in Medicaid/Medicare is preferred.
• Healthcare, provider office or HMO/PPO background preferred.
• Strong knowledge of regulatory requirements concerning Medicare and Medicaid.

Skills

• Excellent problem-solving skills.
• Excellent oral and written communication skills.
• Bilingual language skills a plus.
• Intermediate or stronger skill level with MS Word, Excel, Outlook and PowerPoint.