Healthcare Network Development Specialist

DOCTORS HEALTHCARE PLANS, INC.•Orlando, FL

About The Position

The Healthcare Network Development Specialist is responsible for developing, maintaining, and expanding the provider network in the Orlando and Tampa regions. The role includes developing, administering, and negotiating agreements with physicians, medical groups, ancillary providers, hospitals, and vendors, while ensuring compliance with applicable state and federal regulations. The specialist gathers and verifies credentialing information, ensures agreements are complete and use company-approved forms, analyzes network needs and provider options, and negotiates new agreements and amendments. The position also supports provider contract data integrity, conducts claims and utilization research for provider re-contracting, and completes departmental projects and other assigned duties. Regular travel between locations in the Orlando and Tampa regions is required.

Requirements

Excellent negotiation skills.
Excellent oral and written communication skills.
Bachelor’s degree in health services administration, business, or a related field, or an equivalent combination of training and experience.
Broad financial knowledge.
Knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA, and other federal and state regulatory agencies.
Excellent organizational and customer-service skills.
Versatility.
Ability to travel within the Orlando and Tampa regions.
Ability to work well under pressure and in difficult situations.
Ability to manage a variety of complex issues while advancing key initiatives.
Excellent knowledge and management of risk relationships.

Nice To Haves

Bilingual English/Spanish.

Responsibilities

Ensure contract language complies with State, CMS, AHCA, and other applicable regulatory requirements.
Use only company-approved Provider Agreements.
Obtain credentialing information for new providers and facilities and ensure it is complete and current.
Ensure all information in agreements is complete.
Negotiate agreements for primary care physician, medical specialty care, ancillary care, and hospital services, as well as agreements for providers generally.
Analyze existing networks to determine network needs.
Determine forms of payment, such as capitation, fee-for-service, or trade agreements, in accordance with financial parameters established by the Network Development Department.
Negotiate contract amendments.
Assist in maintaining the integrity of provider database information related to contracts.
Perform claims and utilization research for re-contracting existing network providers.
Conduct comparative analysis of potential providers.
Complete departmental projects as requested and needed.
Perform other job-related duties as assigned by the VP Network Development and/or President/CEO.