Healthcare Contracting Specialist

Provider Network Solutions LLC•Sarasota, FL

5d•$60,000 - $63,000•Remote

About The Position

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.

Requirements

A bachelor’s degree in a related field or equivalent experience related Network Development or Provider Relations experience.
Excellent problem-solving skills.
Excellent oral and written communication skills.
Intermediate or stronger skill level with MS Word, Excel, Outlook and PowerPoint.

Nice To Haves

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.
Bilingual language skills a plus.

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.