Provider Contracting Specialist

General Summary of Duties

The Provider Contractor Specialist is responsible for identifying, recruiting, and negotiating contracts with individual physicians, provider groups, ancillary facilities, and other medical provider groups to join the Prime Health Services PPO network. The contracting process includes negotiations focused on workers’ compensation, commercial group health, auto liability, and personal injury. This position reports to the VP of Network Development.

Essential Job Functions

- Recruits Providers via phone, email, or mail campaigns to negotiate PPO contracts for PHS Core business initiatives;
ensuring contracts are cost effective and in compliance with all State, Federal, and corporate requirements,

- Recruits and manages Specialty Network builds and Special Projects as assigned for PHS Clients via Client Nominations

- Negotiates payment rates and payment terms for new and existing contracts within PHS corporate requirements including terms and conditions associated with State or Federal guidelines

- Performs data analytics of proposed rates to ensure contracts for new and existing Providers align with defined contracting guidelines

- Meets/exceeds daily call metrics, completion of negotiated contracts as defined by contracting leadership, which is subject to review and modification

- Manages and oversees assigned contracting tasks for specified geographic regions

- Ensures contract proposals are complete and accurate prior to sending information to the Provider for review and/or signature

- Submits contractual language reviews to VP of Network Development for review and approval

- Ensures contracts for execution are complete, accurate, and all applicable documentation is present prior to submission to VP of Network Development

- Establishes and maintains productive professional relationships with the provider community

- Resolves escalated contract specific issues of Providers and Clients

- Enters progress reports and notations regarding contracting efforts into PHS proprietary database

- Travel may be required as needed to conduct stewardship meetings with Providers

Education

- Bachelor’s Degree in Communications/Business or healthcare related field of study from an accredited college or university, or equivalent experience required

- 1 + year(s) of experience in managed care contracting and/or healthcare is required

Competencies

- Excellent communication (written and oral), problem solving, and time management skills,

- Experience working in a collaborative, team spirited, and deadline driven environment,

- Must be flexible, adaptable, creative, and self-motivated (initiative),

- Demonstrate strong customer service and public relations skills,

- Demonstrated technical skills proficiency, including Microsoft Office Suite,