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.