Provider Contractor - Specialist

***NOT A REMOTE POSITION***

Description

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

•  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,

Benefits

• Medical Insurance (high deductible plan with an HSA)
• Dental Insurance 
• Vision Insurance 
• Short-term and long-term disability paid by the company
• Group term life paid by the company
• PTO - 160 hours (4 weeks) with the ability to roll over 40 hours and cash out 40 hours at the end of the year
• Fitbit program with monetary rewards
• Employee recognition programs with monetary rewards
• Corporate office amenities - specialty coffee machines, assorted tea options, smoothie bar, collaborative workspaces, fruit provide by company and an onsite market
• Regular employee events such as potlucks, video game tournaments, door decorating contests, Mental Health Awareness Month activities, and a company carnival just to name a few of our past events

About Us

Prime Health Services (PHS) is a national medical cost containment company with a noteworthy PPO Network used by insurance carriers, TPA’s, self-insureds, and governmental entities. Our tech-focused nature allows clients to take advantage of the flexibility of customization while not compromising on bill processing speed. Since 2001, we have specialized in medical provider network development and offer clients a tailored approach to medical cost containment: quality health care at discounted rates.