Healthcare Contracting Specialist

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.

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.

Travel

Yes, 95% of the time or as otherwise required by the company.

Region 6: Hardee, Highlands, Hillsborough, Manatee and Polk

Region 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota