Provider Contracting Specialist
Performs duties to coordinate and support all types of provider contracting in accordance with The Health Plan, State, and Federal guidelines in order to maintain and enhance the provider network and to meet/exceed The Health Plan's accessibility, quality and financial goals;
Maintains records and ensures compliance with the terms of each contract;
Coordinates with other team members to ensure contracts are loaded into the various systems correctly for claims payment, contract accessibility, timely fullfilment of contract obligations, etc.
- Four (4) year college degree in healthcare administration, business administration or related field OR four (4) years managed care industry experience;
- Knowledge of contracting, provider customer service, standard credentialing procedures;
- Knowledge of contracting language and the ability to understand different types of reimbursement models;
- Experience in healthcare or insurance environment;
- Must be able to apply corporate policies and procedures to solve practical problems and deal with a variety of variables in situations where only limited standardization exists;
- Ability to use programs including Word, Excel and Outlook;
- Good written and oral communication skills;
- Ability to interpret and compose spreadsheets, reports and presentations;
- Strong analytical, problem solving and project management skills;
- Must be able to meet deadlines and work under pressure;
- Must be able to work well as part of a team or independently.
- One (1) year contracting experience in a healthcare and/or managed care environment;
- Experience with current managed care, State and/or Federal healthcare programs (Medicare, Medicaid) and the insurance industry.