Provider Contracting Specialist

Prime Health Services, Inc.; Franklin (TN); On-site; USD 85,000 - 110,000; Full time

Job summary

Prime Health Services, Inc. is seeking a Provider Contractor Specialist to identify, recruit, and negotiate contracts with physicians, provider groups, and ancillary facilities to join the PPO network.

You will negotiate rates and terms in compliance with state and federal requirements, analyze proposed rates, and manage contracting tasks across geographic regions, reporting to the VP of Network Development. Travel may be required to meet with providers.

Qualifications

• Bachelor’s degree or equivalent experience in communications/business/healthcare
• 1+ year of managed care contracting experience
• Excellent written and oral communication, problem solving, and time management
• Collaborative, deadline driven, flexible and self-motivated
• Demonstrated customer service and public relations skills
• Proficiency with Microsoft Office Suite

Responsibilities

• Recruits providers and negotiates PPO contracts ensuring cost effectiveness and compliance
• Manages Specialty Network builds and special projects for PHS Clients
• Negotiates payment rates and terms within corporate requirements and guidelines
• Performs data analytics of proposed rates to align with contracting guidelines
• Meets daily call metrics and completes negotiated contracts as required
• Oversees contracting tasks for defined geographic regions
• Ensures contract proposals are complete and accurate prior to provider review
• Submits contract language for VP review and approval
• Maintains productive relationships with provider community
• Resolves escalated contract issues
• Documents progress in PHS database
• Travel may be required for provider stewardship meetings

Skills

Negotiation

Communication

Time management

Problem solving

Data analysis

Education

Bachelor’s Degree in Communications/Business or healthcare related field

1+ year(s) of managed care contracting/healthcare experience

Microsoft Office Suite proficiency

Tools

Microsoft Office Suite

Job description

The Provider Contractor Specialist is responsible for identifying, recruiting, and negotiating contracts with individual physicians, provider groups, ancillary facilities, and other medical provider groups to join the Prime Health Services PPO network. The contracting process includes negotiations focused on workers’ compensation, commercial group health, auto liability, and personal injury. This position reports to the VP of Network Development.

Essential Job Functions

• Recruits Providers via phone, email, or mail campaigns to negotiate PPO contracts for PHS Core business initiatives; ensuring contracts are cost effective and in compliance with all State, Federal, and corporate requirements,
• Recruits and manages Specialty Network builds and Special Projects as assigned for PHS Clients via Client Nominations
• Negotiates payment rates and payment terms for new and existing contracts within PHS corporate requirements including terms and conditions associated with State or Federal guidelines
• Performs data analytics of proposed rates to ensure contracts for new and existing Providers align with defined contracting guidelines
• Meets/exceeds daily call metrics, completion of negotiated contracts as defined by contracting leadership, which is subject to review and modification
• Manages and oversees assigned contracting tasks for specified geographic regions
• Ensures contract proposals are complete and accurate prior to sending information to the Provider for review and/or signature
• Submits contractual language reviews to VP of Network Development for review and approval
• Ensures contracts for execution are complete, accurate, and all applicable documentation is present prior to submission to VP of Network Development
• Establishes and maintains productive professional relationships with the provider community
• Resolves escalated contract specific issues of Providers and Clients
• Enters progress reports and notations regarding contracting efforts into PHS proprietary database
• Travel may be required as needed to conduct stewardship meetings with Providers

Education

• Bachelor’s Degree in Communications/Business or healthcare related field of study from an accredited college or university, or equivalent experience required
• 1 + year(s) of experience in managed care contracting and/or healthcare is required
• Excellent communication (written and oral), problem solving, and time management skills,
• Experience working in a collaborative, team spirited, and deadline driven environment,
• Must be flexible, adaptable, creative, and self-motivated (initiative),
• Demonstrate strong customer service and public relations skills,
• Demonstrated technical skills proficiency, including Microsoft Office Suite,