Provider Network Development Lead - Negotiation & Partnerships

Doctors HealthCare Plans, Inc.; Orlando (FL); On-site; USD 90,000 - 140,000; Full time

Job summary

Doctors HealthCare Plans, Inc. in the Orlando/Tampa region seeks a Network Development professional to develop, administer, and expand our provider agreements across physician groups, hospitals, ancillary and vendor partners while ensuring regulatory compliance.

The role requires strong negotiation, English/Spanish communication, and regular travel to credential, analyze, and finalize contracts. You will help optimize network performance and provider relations in a dynamic healthcare environment.

Qualifications

• Excellent negotiation skills.
• Requires regular travel between locations in the Orlando and Tampa regions.
• Excellent oral and written communication skills.
• Bilingual English/Spanish preferred.
• Bachelor’s degree in health services administration, business or related field or an equivalent combination of training and experience.
• Demonstrates a broad-scope of financial knowledge.
• Knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines.
• Excellent organizational and customer skills.
• Versatility.
• Excellent customer skills.
• Ability to travel within the Tampa and Orlandoregion.
• Ability to work well under pressure and difficult situations.
• Capable of managing a variety of complex issues while driving momentum of key initiatives.
• Excellent knowledge and management of risk relationships.

Responsibilities

• Develop, administer and negotiate Provider Agreements for Primary Care Physician Services, Medical Specialty Care Services, Ancillary Care Services and Hospital Services.
• Negotiate amendments to contracts and ensure compliance with State, CMS, AHCA and other regulatory guidelines.
• Obtain credential information for new providers and facilities and ensure completeness and current information.
• Ensure completeness of all information in the agreements.
• Negotiate agreements for all providers across the network.
• Conduct analysis to determine the needs of the existing networks and form payment structures (capitation, FFS or trade) per financial parameters.
• Maintain provider data integrity related to contracts in the system.
• Perform claims and utilization research for re-contracting existing network providers.
• Perform comparative analysis of potential providers.
• Contribute to departmental projects and initiatives as requested by VP Network Development or President/CEO.

Skills

Negotiation

Communication skills

Bilingual English/Spanish

Travel required

Financial knowledge

Risk management

Customer service

Education

Bachelor's degree in health services administration, business or related field

Job description

Doctors HealthCare Plans, Inc. in the Orlando/Tampa region seeks a Network Development professional to develop, administer, and expand our provider agreements across physician groups, hospitals, ancillary and vendor partners while ensuring regulatory compliance.

The role requires strong negotiation, English/Spanish communication, and regular travel to credential, analyze, and finalize contracts. You will help optimize network performance and provider relations in a dynamic healthcare environment.