Healthcare Provider Contracting Specialist

4 days ago


Los Angeles, California, United States Nexus HR Services Full time
Job Summary

Nexus HR Services is seeking a skilled Healthcare Provider Contracting Specialist to join our team. As a key member of our Network Development department, you will play a critical role in developing and managing provider relationships and contracting efforts with healthcare providers, group practices, and ancillary providers.

Key Responsibilities
  • Develop and maintain strong relationships with healthcare providers, group practices, and ancillary providers to ensure access standards are met.
  • Liaise between network providers and our organization to monitor provider performance and ensure compliance with network adequacy and client market needs.
  • Promote strategic initiatives and provide training to network providers on policy and procedure updates.
  • Maintain accurate documentation for all provider contracts via our CRM system.
  • Collect and upload required documents from providers, including W-9s, rosters, and credentialing applications.
  • Negotiate and renegotiate contracts with primary care, specialty physicians, and ancillary providers for all product lines.
  • Conduct provider orientations and ongoing education to ensure network providers have the necessary knowledge and skills.
  • Explain fee-for-service and risk contracts to providers and provide reporting on provider and/or service fund performance.
  • Manage provider networks by developing and maintaining relationships to drive business results within a specific geographic area.
  • Interface daily with providers and internal constituents to resolve service issues in a timely manner.
Requirements
  • 3 years of experience in healthcare provider contracting.
  • 2 years of experience working with large health systems, FQHCs, RHCs.
  • 2 years of experience working with large multi-specialty groups.
  • Must have experience working for an IPA or a Medical Group.
  • Must have experience in insurance company or other payer building provider networks/contracting with physician practices, ancillary providers, facilities, or hospitals.
  • Able to work in Southern, San Bernardino, Riverside, and Central California territories as needed.
  • Ability to speak fluent Spanish is highly preferred.
What We Offer
  • Dental
  • Vision
  • Medical
  • 401k
  • Paid Leave
  • Others


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