CareNu
Network Contracting Specialist
CareNu, Tampa, Florida, us, 33646
It's inspiring to work with a company where people truly BELIEVE in what they're doing!
When you become part of the CareNu Team, you'll realize it's more than a job. It's a mission. We're committed to providing groundbreaking solutions for our clients' unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success!
Role:
The Network Contracting Specialist initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance.
**This is a hybrid role that requires 3-4 days in the corporate office/week**
Qualifications: Bachelor's degree with emphasis in Health Insurance/Healthcare Administration, Finance or Business 3 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures and reimbursement rates to providers. Ability to develop and maintain excellent working relationships with both the internal team and external vendors Business knowledge and competency in accounting and analysis Working knowledge of regulatory requirements Ability to work both independently and with a team Able to work under minimal supervision, exercising discretion and independent judgment to solve problems Team player and self-starter who is accurate and detail-oriented Proficient in time management skills with the ability to prioritize a variety of duties Job Responsibilities:
Communicates contract terms, payment structures, and reimbursements rates to providers. Prepare provider contracts and monitor process to ensure timely execution of contracts. Monitor and oversee provider contract compliance and issue corrective action letters for non-compliance. Provides a single point of accountability for facilitating complex contract loading and ensuring optimal provider service delivery and database accuracy. Researches and resolves complex issues for multiple business areas to assure accurate reimbursement based on provider contract and area fee schedules. Prepare and analyze reports and records on functional area and on organizational activities, recommend improvements for upper management. Monitor operational and financial performance of agreements using results to guide future negotiations. Review redline contract language and provide accept/decline recommendations to management. Competencies:
Satisfactorily complete competency requirements for this position. Responsibilities of all employees:
Represent the Company professionally at all times through care delivered and/or services provided to all clients. Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse. Comply with Company policies, procedures and standard practices. Observe the Company's health, safety and security practices. Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company. Use resources in a fiscally responsible manner. Promote the Company through participation in community and professional organizations. Participate proactively in improving performance at the organizational, departmental and individual levels. Improve own professional knowledge and skill level. Advanced electronic media skills. Support Company research and educational activities. Share expertise with co-workers both formally and informally. Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Compensation Pay Range: $64,074.00 - $96,111.00
This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.
When you become part of the CareNu Team, you'll realize it's more than a job. It's a mission. We're committed to providing groundbreaking solutions for our clients' unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success!
Role:
The Network Contracting Specialist initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance.
**This is a hybrid role that requires 3-4 days in the corporate office/week**
Qualifications: Bachelor's degree with emphasis in Health Insurance/Healthcare Administration, Finance or Business 3 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures and reimbursement rates to providers. Ability to develop and maintain excellent working relationships with both the internal team and external vendors Business knowledge and competency in accounting and analysis Working knowledge of regulatory requirements Ability to work both independently and with a team Able to work under minimal supervision, exercising discretion and independent judgment to solve problems Team player and self-starter who is accurate and detail-oriented Proficient in time management skills with the ability to prioritize a variety of duties Job Responsibilities:
Communicates contract terms, payment structures, and reimbursements rates to providers. Prepare provider contracts and monitor process to ensure timely execution of contracts. Monitor and oversee provider contract compliance and issue corrective action letters for non-compliance. Provides a single point of accountability for facilitating complex contract loading and ensuring optimal provider service delivery and database accuracy. Researches and resolves complex issues for multiple business areas to assure accurate reimbursement based on provider contract and area fee schedules. Prepare and analyze reports and records on functional area and on organizational activities, recommend improvements for upper management. Monitor operational and financial performance of agreements using results to guide future negotiations. Review redline contract language and provide accept/decline recommendations to management. Competencies:
Satisfactorily complete competency requirements for this position. Responsibilities of all employees:
Represent the Company professionally at all times through care delivered and/or services provided to all clients. Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse. Comply with Company policies, procedures and standard practices. Observe the Company's health, safety and security practices. Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company. Use resources in a fiscally responsible manner. Promote the Company through participation in community and professional organizations. Participate proactively in improving performance at the organizational, departmental and individual levels. Improve own professional knowledge and skill level. Advanced electronic media skills. Support Company research and educational activities. Share expertise with co-workers both formally and informally. Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Compensation Pay Range: $64,074.00 - $96,111.00
This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.