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Provider Contractor
2 weeks ago
*NOT A REMOTE JOB* *HYBRID OR IN OFFICE ONLY*
The Provider Contractor - Specialist is responsible for identifying, recruiting, and contracting individual physicians physician groups ancillary facilities, and other medical provider groups to join the Prime Health Services' PPO network with per product, defined contractual reimbursement rates contained within defined parameters that meet/exceed industry expectations. The contracting process, based primarily on client nominations, includes negotiations focused on workers' compensation, commercial group health, auto liability, and personal injury.
Essential Job Functions
- Contacting (call/email) medical providers to negotiate managed care PPO contracts, ensuring a cost effective contract in compliance with all State, provider, and corporate requirements
- Analyzing data to develop strategies for contracting and re-contracting
- Developing and maintaining relationships with medical providers
- Entering progress reports and notations regarding contracting efforts into Prime's proprietary database
- Elevating requests for contractual language change to the Director of Provider Contracting
- Traveling, up to 50%) may be required as needed, i.e. conduct stewardship meetings with providers
- 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
Education
- Bachelor's Degree in Communications/Business or related field of study from an accredited college or university, or equivalent experience required
- Specialist level requires 2 + years of sales (direct/indirect) experience and/or proven contracting performance
- Managed care contract experience and/or healthcare experience is preferred
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