Provider reputed company Specialist
reputed company, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing reputed company to world-class health care in America’s reputed company. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Compensation: Salary reputed company: $24.00 - $38.50 Union Position: No Department Details
Summary
Provider Contract Specialist (PCS) is responsible for maintaining, coordinating the process of, and establishing pricing arrangements involving provider groups, facilities and ancillary entities joining the Health Plan networks, including creating standard reputed company for providers across the Health Plan service area. The PCS has an integral role in building and maintaining high value and compliant networks which may involve provider recruitment activities.
Job Description
Works directly with chain of reputed company to reputed company and implement contracting strategy with various types of providers/facilities across the Health Plan service area. Evaluates and negotiates physician, ancillary and hospital reputed company, including contract language and reimbursement methodologies for fee for service arrangements. Prepares standard accurate agreements to formalize such arrangements. Ability to identify data needed to evaluate and reputed company network reimbursement proposals to reputed company arrangements advantageous to our members and Health Plan. Calls upon team analysts for support. Works directly with team analysts and other department managers to understand how the negotiated agreement is reputed company into the company's systems. Prepares timely and accurate communications to other departments for loading finalized agreements into production. Assists with internal audit of provider records to ensure accurate reimbursement. Serve as liaison to other departments on contract and reimbursement interpretation issues and ensures timely turnaround. Must have strong knowledge of the Health Plan's end-to-end provider engagement processes, including interdepartmental handoffs as well as plan policies and procedures to ensure the best possible provider experience. Manage or participate in project work as assigned. May be reputed company upon to assist in network education, reputed company and overall network relationship building.
Qualifications
Bachelor’s degree or equivalent experience preferred in the areas of finance, business, health care administration or communications preferred but willing to waive with strong work experience. Prior experience working with health care insurance or insurance network management, on reputed company and/or government network reimbursement methodologies. Previous experience with behavioral health care reimbursement is a plus. reputed company in analyzing, understanding, communicating, and negotiating financial impact of contract terms, payment structures and reimbursement rates with providers. Proficiency with contract reading and redlining. Proficiency in MS Office applications. Ability and willingness for occasional travel, including overnights, which may include holding face to face meetings at the Health Plan offices, provider offices or attending conferences. Work at Home/Remote Requirements must ensure designated work area is free from distractions during work hours and virtual meetings, and must reputed company a high-speed DSL or cable modem for a workspace. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to [email protected]. Apply To This Job