Provider Network Growth & Negotiation Lead

Doctors HealthCare Plans, Inc.; Miami (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

Doctors HealthCare Plans, Inc. in South Florida seeks a Network Development professional to build, administer and expand the provider network, negotiating physician, medical group, ancillary, hospital and vendor agreements.

You will ensure contracts meet state and federal guidelines and coordinate credentialing across providers. The role involves negotiating provider agreements, maintaining data accuracy, and performing analyses to support network growth.

Qualifications

• Bachelor’s degree in health services administration, business or related field.
• Excellent negotiation and communication skills.
• Knowledge of Medicare Advantage operational and regulatory guidelines.
• Ability to travel regularly within the Miami/Dade region.
• Experience with provider contracts and data management is preferred.

Responsibilities

• Ensure contract language complies with State, CMS, AHCA, and regulatory guidelines.
• Use only company approved Provider Agreements.
• Obtain credential information for new providers and facilities.
• Ensure completeness of all information in agreements.
• Negotiate Provider Agreements for physician, medical, ancillary and hospital services.
• Negotiate amendments to contracts.
• Maintain provider data base system integrity related to contracts.
• Perform claims and utilization research for re-contracting providers.
• Conduct comparative analysis of potential providers.
• Support departmental projects as requested by VP Network Development or President/CEO.

Skills

Excellent negotiation skills

Excellent oral and written to?mb ...

Education

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

Job description

Doctors HealthCare Plans, Inc. in South Florida seeks a Network Development professional to build, administer and expand the provider network, negotiating physician, medical group, ancillary, hospital and vendor agreements.

You will ensure contracts meet state and federal guidelines and coordinate credentialing across providers. The role involves negotiating provider agreements, maintaining data accuracy, and performing analyses to support network growth.