Provider Network Development & Contract Negotiator

Doctors HealthCare Plans, Inc.; Coral Gables (FL); On-site; USD 120,000 - 180,000; Full time

Job summary

Doctors HealthCare Plans, Inc. seeks a senior Network Development professional to grow and manage our provider network, including physicians, medical groups, hospital and ancillary services.

You will negotiate agreements that meet CMS/AHCA guidelines and protect company interests. Role requires strong negotiation, credentialing oversight, data management and cross-functional collaboration to maintain a robust, compliant network while expanding partnerships and ensuring timely credentialing

Qualifications

• Excellent negotiation skills.
• Excellent oral and written communication skills.
• Bilingual English/Spanish preferred.
• Bachelor’s degree in health services administration, business or related field.
• Knowledge of CMS/AHCA and other regulatory guidelines.
• Strong organizational and customer service skills.

Responsibilities

• Negotiate Provider Agreements for various services and providers.
• Ensure contract language compliance with state, CMS, AHCA and other regulators.
• Obtain credential information for new providers and facilities.
• Maintain completeness of all agreement information.
• Conduct analyses to determine network needs and form payment terms.
• Negotiate amendments to contracts and manage provider data integrity.
• Perform claims and utilization research for re-contracting.
• Coordinate department projects as needed with VP Network Development.

Skills

Negotiation skills

Oral and written communication

Bilingual English/Spanish preferred

Financial knowledge

Regulatory knowledge (CMS/AHCA)

Organizational skills

Customer service skills

Ability under pressure

Problem solving

Education

Bachelor’s degree in health services administration or related field

Job description

Doctors HealthCare Plans, Inc. seeks a senior Network Development professional to grow and manage our provider network, including physicians, medical groups, hospital and ancillary services.

You will negotiate agreements that meet CMS/AHCA guidelines and protect company interests. Role requires strong negotiation, credentialing oversight, data management and cross-functional collaboration to maintain a robust, compliant network while expanding partnerships and ensuring timely credentialing