GENERAL SUMMARY
Responsible for physician, ancillary and hospital contracting and for performing ongoing network analysis for all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation. Recruits and contracts with individual providers who meet established selection criteria to assure adequate geographic and specialty coverage.
ESSENTIAL RESPONSIBILITIES
- Assesses, recruits and organizes vendors for all networks.
- Negotiates complex contracts with physician, ancillary, and hospital providers for all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation.
- Manages the establishment and continual updating of provider databases.
- Reviews and facilitates Requests for Proposals (RFPs) from ancillary providers whose services match a need for entering into a contract.
- Oversees maintenance of working relationships within the existing network and assists in the recruitment of new providers.
- Assists department personnel in resolving contract disputes related to claims inquiry.
- Acts in an advisory capacity to legal with regard to the financial and legal impact of provider contract language requested.
- Develops and generates appropriate reports on size, magnitude, cost effectiveness and comparative marketability of all networks for internal and external customers.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- At least 2-4 years experience as a Provider Contracting Representative.
- Proven ability to handle complex provider service issues.
- Significant experience (usually 5+ years) exposure to benefits interpretation and provider networking
- Substantive knowledge of managed care policy and direction.
- Knowledge of ICD-9 and CPT codes desired.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Tampa, FL, US
Organization: 32000 - Florida Health Plan Admin. LLC
Schedule: Full-time
Job Posting: 2013-01-18 00:00:00.0
Job ID: 1310231