Provider Network Development Specialist
About The Position
The Provider Network Development Specialist is responsible for developing, maintaining, and expanding the provider network in the South Florida region. The role includes developing, administering, and negotiating agreements with physicians, medical groups, ancillary providers, hospitals, and vendors in compliance with applicable state and federal regulatory guidelines. The position also supports provider credentialing and contract-data integrity, assesses network needs and potential providers, and conducts claims and utilization research related to provider re-contracting. The role may include departmental projects and other related duties assigned by the VP Network Development and/or President/CEO.
Requirements
- Excellent negotiation skills.
- Excellent oral and written communication skills.
- Regular travel between locations in the Miami/Dade region is required.
- 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 guidelines.
- Excellent organizational and customer-service skills.
- Versatility.
- Ability to work well under pressure and in difficult situations.
- Ability to manage a variety of complex issues while driving momentum on key initiatives.
- Excellent knowledge and management of risk relationships.
Nice To Haves
- Bilingual English/Spanish preferred.
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 other providers.
- Analyze the needs of existing provider networks.
- Determine payment arrangements, including capitation, fee-for-service, or trade agreements, based on financial parameters established by the Network Development Department.
- Negotiate contract amendments.
- Assist in maintaining the integrity of the provider database as it relates 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.
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What This Job Offers
Job Type
Full-time
