Our client is a private equity backed integrated healthcare organization that is expanding in South Florida. We are seeking a dynamic Network Contract Specialist to develop a provider network yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance, trend management, and produces an affordable and predictable product for customers and business partners.
Essential Functions
- Strategizes positioning for contracting with providers and developing networks in outlying areas.
- Initiates and maintains effective channels of communication with providers, internal and external customers.
- Manages contracting with providers (e.g., Ancillaries – Home Health, DME, and IV).
- Conducts negotiations and drafts individual and group contracts.
- Ensures the smooth operation and administration of provider agreements.
- Works with current and perspective clients to include physicians, hospitals, home health agencies, clinics and other potential referral resources in specified territory.
- Maintains effective time management, promote excellent customer service, and support company’s culture at all times.
- Manages expense/budget appropriately.
- Manages and nurtures relationships with existing and prospective Network Providers
- Ability to build or augment a homecare network in multiple States and geographies
- Assists Network Manager with contracts by ensuring all credentialing documentation is received and documented.
- Ability to communicate with Corporate, National, Local network providers at all levels within their organization
- Negotiate contractual rates / reimbursement fees
- Works closely with OHS Medical Economics Team to determine contractual rate structures
- Participates in the upkeep of all Provider credentialing documentation.
- Develops leads based on corporate objectives or geographic area, as assigned.
- Evaluates or monitors contract performance to determine necessity for amendments or extensions of contracts and compliance to contractual obligations.
- Ensures all providers have formalized and accurate contracts.
- Works within existing operational policies, procedures and protocols..
- Assist in analyzing service agreements, financial reports, and other data to determine reasonableness of contracts.
- Establish and maintain positive long-term provider contract relationships.
- Coordinates and conduct provider site visits as needed for credentialing purposes, as necessary.
- Ensures strict standards for claimant/client confidentiality and complies with organizational and governmental regulations/policies.
Background / Experience Desired
- Ability to communicate fluently in English and Spanish language is required. (Read, Write, Speak)
- Exposure to procedure interpretation and provider networking
- Has a demonstrated understanding of the relationships between Health plans, providers and Referral sources in local, regional, national market.
- Strong analytic, negotiations, problem solving and issue resolutions abilities.
- Proficient customer service and or sales experience.
- Excellent working knowledge of MS office applications (Word, Excel, PowerPoint).
- Minimum 3 years of relevant business experience in Network management.
- 2 Experience in the healthcare
- Post-secondary education or related experience equivalent.