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Provider Contracting Specialist
1 month ago
Provider Contracting Specialist
Position Summary: Responsible for all aspects of physician and group practice recruitment and contracting for the Verity Networks including the commercial, Medical, Medicaid and health insurance exchange plans.
Essential Functions:
•Performs outbound calls regarding provider nominations and recruitment.
•Manages entire contracting process of assigned physician and group practices including preparation of documents, negotiation, follow-up, and documentation of activities in contract management system.
•Responsible for auditing provider demographic data for integration into provider data management system.
•Ensures interpretation of the contract for operational needs.
•Ensures that all contracts are in compliance with business requirements.
•Plans proactively for all contract renewals and potential reimbursement changes; completes renewal process.
•Coordinates data collection with Operations to ensure all data is accurately loaded for provider directories and claims processing.
•Acts as liaison to providers; Assists with questions regarding fee schedule allowable and claim issues.
•Recommend and participate in process improvement opportunities for daily operations.
•Manages appropriate provider correspondence including maintenance of the paper and electronic filing systems for provider agreements.
•Coordinates provider interactions with the entire team to ensure provider satisfaction.
Requirements:
Experience in provider contracting, managed care, healthcare, or physician office operations is preferred.
•Demonstrated proficiency in WORD and EXCEL is required.
•Ability to do both internal and external research related to provider status, data collection and reimbursements to prepare for network development and contracting.
•Must project a professional image while interacting with a variety of personalities in person, over the telephone or via electronic mail.
•Must have a general understanding of managed care concepts and contracting.
•Must have basic negotiation skills and a desire to enhance skills.
A qualified candidate will be a self-starter who has strong attention to detail. Time management and follow-through are important assets in this position. The individual's ability to communicate and work in a team environment will be essential to succeed in this position.
This is a full-time, in office position
Company Information
Verity HealthNet is committed to revolutionizing the way healthcare is delivered by making a positive impact on the lives of patients and providers alike. We believe in a diverse, inclusive workplace and are always looking for creative, analytical, innovative, and passionate thinkers and doers who are driven to learn as well as succeed. Choosing to work for Verity HealthNet means being part of a team that values collaboration, candor, and integrity.
Verity HealthNet is a company that fosters a supportive work environment, where employees are encouraged to contribute their unique perspectives and ideas and have the opportunity to be at the forefront of groundbreaking healthcare solutions. By investing in our workforce, Verity empowers its employees' growth and development by offering competitive hourly/salary wages and career progression. We help support our employees' career initiatives, both professionally and personally, while maintaining a healthy work/life balance.
A career at Verity HealthNet offers an exceptional opportunity to be part of a forward-thinking organization that is transforming healthcare. With a supportive work environment, a commitment to innovation, a focus on employee growth and culture, and a dedication to improving healthcare outcomes, Verity HealthNet is an ideal choice for individuals passionate about making a meaningful difference in the healthcare industry, leading to a tangible impact on the lives of patients and their communities.
