Healthcare Provider Relations / Contracting Representative

Summary:
As a Network Development Representative, you will play a pivotal role in establishing and nurturing Specialty Benefits Networks across various Markets/States. Your focus will be on fostering relationships, negotiating costs, and ensuring the adequacy of these networks to meet expected membership volumes. Collaborating closely with Provider Leads, you'll engage in contracting activities with identified Specialty Benefit providers while supporting growth objectives and strategic expansion efforts. Join us in our mission to build robust networks that enhance access to quality healthcare services.
Responsibilities:
Identify and target potential providers to establish contractual agreements.
Ensure alignment with Corporate Playbook in all day-to-day activities.
Collaborate with strategic leaders to garner support for expansion efforts and administer contract arrangements with Health Plans/Payers.
Travel to provider offices as necessary to secure Specialty Benefit provider contracts.
Support business development and corporate growth initiatives.
Recruit, negotiate, contract, and re-contract with Specialty Benefit providers across all 'Levels of Service' to ensure quality and cost-effectiveness.
Assist in contracting efforts for new products/risk strategies and help develop new service areas.
Contribute to the development of strategic initiatives relating to provider networks, including expansions and new payment methods.
Work with the provider relations team to maintain a comprehensive provider network that meets access standards and delivers a full range of healthcare services.
Analyze and ensure provider networks meet all CMS access standards across geographic areas.
Facilitate internal and external communication regarding provider-related issues and participate in key organizational committees.
Act as a liaison and contracted health plans concerning Specialty Benefit provider network participation.
Assist the Credentialing Department by collecting physician credentials for newly contracted providers.
Requirements:
Associates Degree preferred.
1 to 2 years of experience with Specialty Benefit providers and downstream provider contracting.
Knowledge of provider reimbursement strategies for Managed Care, government products, and commercial products.
Valid driver's license and ability to pass DMV record check.
Join our team and make a meaningful impact in shaping the future of healthcare delivery!
Employment Type: Full-Time
Salary: $ 46,783.00 Per Year