Contracting Specialist – North FL

Position Summary

Position to cover contracting in North Florida for all active and future specialties. Areas of coverage include Region 1, Region 2, Hamilton, Suwannee, Columbia, Lafayette, Union, Bradford, Dixie, Gilchrist, Alachua, Putnam, Baker, Nassau, Duval, Clay, & St. Johns counties.

Manages the physician networks by developing and maintaining relationships to drive business results within a specific geographic area.  Provides service and education to Network Providers and staff.  Works in concert with medical management and provider relations developing actions to meet market growth and medical cost targets

Duties and Responsibilities

  • Contracting Duties:
    • Develop provider networks for initial and/or expansion review and approval after satisfying or exceeding the minimum network standards according to the membership needs for the health plan partners.
    • Obtain leads for prospective physicians, manages all incoming new provider leads and follows-up with the providers on the status of their new contractual agreement.
    • Ensures that the provider network consists of Board Certified/Board Eligible Dermatologist, Podiatrist, Orthopedic providers and all other specialties as contracted by the network.
    • Identifies network gaps and conducts recruitment efforts to address the deficiencies.
    • Strategize to maintain an adequate network during monthly Geo Access reviews.
    • Liaison in conjunction with all Contracting Specialists, including but not limited to, grievances, Network gaps, and expansion requests.
  • Work in conjunction with Contracting Coordinator for all health plans.
  • Special projects as assigned or directed.
  • This position may include travel to counties outside of the above specified territory as assigned.

Knowledge

  • A Bachelor’s Degree in a related field or equivalent experience related Network Development or Provider Relations experience.
  • Minimum three (3) years’ experience in Medicaid/Medicare is preferred.
  • Healthcare, provider office or HMO/PPO background preferred.
  • Strong knowledge of regulatory requirements concerning Medicare and Medicaid.

Skills

  • Excellent problem solving skills.
  • Excellent oral and written communication skills.
  • Bilingual language skills a plus.
  • Intermediate or stronger skill level with MS Word, Excel, Outlook and PowerPoint.

Abilities

  • Must be organized and have excellent time management capabilities.
  • Ability to analyze data to identify trends and variance from goals.

Physical Demands

The physical demands described here are representative of those that must be met by the employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle or feel; reach with hands and arms and talk and hear.  The employee is occasionally required to stand; walk and stoop, kneel or crouch.  Specific vision abilities required by this job include close vision and ability to adjust focus.

Position Type/ Expected Hours of Work

This is a full time position.   Days and hours of work are Monday through Friday general time span: 8:00 a.m. to 5:00 p.m. Occasional evening and weekend work may be required as job duties demand.

Work Environment

This job operates in a clerical office setting.  This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.  The work environment characteristics described here are representative of those encountered while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Travel

Yes, 80 % of the time or as otherwise required by the company.

Other Duties

Please note this job description is not designated to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.  Duties, responsibilities and activities may change at any time with or without notice.

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