Provider Network Contracting and Credentialing
|Fort Lauderdale, Florida - United States
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WHY IS THIS A GREAT OPPORTUNITY?
Our client is a rapidly growing integrated health care organization that meets the needs of health plans by serving its members through a value-based, full-risk model for integrated post-acute and home-based care. Patients, plans, and providers have the same goal – healing at home. The unique model offers a single point of accountability for care in the home to its health plan and provider partners, serving more than one million health plan members nationwide.
The mission is to bring healing home and help improve patient outcomes and quality of life, reducing hospital readmission rates, and lowering costs.
We are looking for an experienced Network Specialist in South Florida.
This important role is responsible for developing 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.
- Strategize positioning for contracting with providers and developing networks in outlying areas.
- Initiate and maintain effective channels of communication with providers, internal and external customers.
- Manage contracting with providers (e.g., Ancillaries – Home Health, DME, and IV).
- Conduct negotiations and draft individual and group contracts.
- Ensure the smooth operation and administration of provider agreements.
- Demonstrate knowledge of Providers in assigned geographic area. Has a demonstrated understanding of the relationships between Health plans, Providers, and Referral sources in local, regional, and national markets.
- Work in the field promoting homecare services.
- Build relationships with current and prospective clients to include physicians, hospitals, home health agencies, clinics, and other potential referral resources in specified territory.
- Maintain effective time management, provide excellent customer service, and support culture.
- Ongoing product/service knowledge
- Responsible for pre-arranged meetings and “cold calling” efforts.
- Communicate with Corporate, National, and Local network providers at all levels within their organization.
- Ability to negotiate contractual rates/reimbursement fees.
- Assist the Medical Economics Team to determine contractual rate structures.
- Participates in the upkeep of all Provider credentialing documentation.
- Develop leads based on corporate objectives or geographic area, as assigned.
- Work in a team environment to ensure support of others based on workloads, knowledge/expertise, and previous experience.
- Analyze service agreements, financial reports, and other data to determine reasonableness of contracts.
- Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
- Coordinate and conduct provider site visits as needed for credentialing purposes, as necessary.
- Ensure strict standards for claimant/client confidentiality and comply with organizational and governmental regulations/policies.
- Bilingual English/Spanish preferred
- Exposure to procedure interpretation and provider networking.
- Superior verbal and written communication skills.
- Strong analytic, negotiation, problem solving, and issue resolution abilities.
- Proficient customer service and/or sales experience.
- Excellent working knowledge of MS office applications (Word, Excel, PowerPoint)
- A minimum of three (3) years of relevant business experience in Network management.
- Atleast Two (2) years of healthcare experience.
University - Bachelor's Degree/3-4 Year Degree