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Provider Relations

Miramar, FL · Healthcare
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.
 
 
 
Contact information:
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Recruiter
Max Populi, LLC
4628 Bayard Street, #207
Pittsburgh, PA 15213-2750
Tel: (412) 567-5279
Fax: (412) 567-5198
e-mail: jobs@maxpopuli.com
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