Provider Negotiations Specialist - Not Remote
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About The Position
The Provider Negotiations Specialist is a critical role within Prime Health Services, focusing on the review and negotiation of medical bills and documentation. This position is not remote and is based at our Franklin, TN office. The primary responsibility of the Provider Negotiations Specialist is to negotiate cost-effective single case prospective and retrospective agreements with out-of-network providers, including physicians, healthcare facilities, and ancillary providers. This role requires a collaborative approach, working closely with Prime Corrections on cases involving medical bills for inmates that necessitate a Single Case Agreement (SCA) or negotiation. Additionally, the Specialist will collaborate with Customer Relations to address medical bills for members that require similar agreements. In this role, the Specialist will develop, coordinate, and complete thorough analyses of medical bills and documentation to ensure timely reviews and preparation of single case payment arrangements. The position also involves contract recruitment, negotiations, and renegotiations of assigned core contract targets, as well as any special contract projects that may arise. Establishing and maintaining positive relationships with providers and their Business Office Managers is essential for success in this position. The Provider Negotiations Specialist must be detail-oriented, organized, and possess effective time management skills to thrive in a fast-paced and changing environment.
