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Provider Contract Management Specialist

2 months ago

Birmingham, United States NaphCare Full time

Overview:

The Provider Contracting Specialist Prisons negotiates, executes, administers, and manages hospital and physician contracts in accordance with company standards to ensure we meet and exceed quality and financial goals, and contract compliance. They will lead all aspects of provider network strategy including access analysis, network operations, and analysis related to payment and cost management. They will develop strong relationships with hospital executive teams, providers, and practice administrators in order to achieve network growth and cost targets. The Provider Contracting Specialist Prisons must have excellent written, verbal, negotiation, and interpersonal skills; be customer-service oriented; have the ability to problem solve and strategically plan; be well-organized; and work and perform independently in negotiations.

Responsibilities:

The Provider Contracting Specialist Prisons will be responsible for building and maintaining hospital and physician networks with off-site community providers to ensure competitive rates and contract language aligned with government contract terms and state and federal statutes related to inpatient stays. The position requires drafting contract proposals and supporting documents, performing basic cost analysis functions, analyzing business practices, negotiating reimbursement rates, cold calling, researching regulatory statutes and market conditions, and contract language review. The Provider Contracting Specialist Prisons will be expected to meet and negotiate independently with high level hospital executives, practice administrators, and physicians, as well as conduct in-service orientation meetings with key executives, hospital departments, or provider personnel. The Provider Contracting Specialist Prisons will serve as a resource to help reduce cost, achieve effective utilization and quality goals and objectives, and utilize information to develop and support management decisions. They work closely with the Director of Contracting and Network Development to assist in the formulation and coordination of bid proposals, satisfying all requirements of an RFP related to off-site operations. The position requires the ability to prepare reports and required documents for management review, as appropriate.

Qualifications:
  • Bachelor's degree required; masters degree in health care administration or business administration preferred
  • A minimum of 3-5 years of healthcare experience in addition to 3-5 years in healthcare contracting.
  • Experience in corrections contracting preferred
  • Advanced knowledge and understanding of Medicare and Medicaid reimbursement are required
  • Negotiating provider contract language required; Functional understanding of multiple reimbursement methodologies preferred
  • Good communication and organizational skills and the ability to interact positively with outside clients, co-workers and supervisors
  • Ability to effectively interact with and present information regarding services to practice administrators, physicians, and hospital executives
  • Ability to work effectively in a fast-paced, results oriented environment; and exercise a high degree of initiative, judgment, discretion, and decision making to achieve organizational objectives
  • Must be able to multi-task and work independently
  • Ability to travel up to 10%-20%

  • Experience in corrections contracting preferred

  • Other duties as assigned