Managed Care that Works for Everyone
Prime Network Provider Spotlight
NORTHSIDE HOSPITAL

SAINT PETERSBURG, FL
   About Us
Employment Job Title: Network Development Coordinator

Job Title:  Network Contractor

 

The Network Contractor is responsible for recruiting and negotiating preferred provider (PPO) contracts with physicians, ancillaries and hospitals for Medicaid/Medicare, Commercial Health, Worker’s Compensation and International Health plans. Reporting to the network contracting team leader, the network contractor must be a creative, self starter - able to work well with other team members in a fast-paced, growth oriented environment. Experience building national or regional networks is a must. Specific areas of expertise include governmental products, contract language and reimbursement negotiations and provider relations.

 

Essential Responsibilities:

 

  • Recruiting and negotiating contracts with hospitals, physicians and other medical provider groups.
  • Assist department personnel in resolving contract disputes related to claims inquiry.
  • Analyze and use data to develop strategies for contracting and re-contracting.
  • Maintain accurate records, manage and update provider database.
  • Develop and generate appropriate reports.
  • Perform other duties as required.

Job Requirements:

 

  • Minimum 3 years of experience as a Provider Contracting Representative showing proven success in the recruitment of medical providers to Medicaid and group health networks.
  • Possess excellent organizational, oral and written communication, problem solving and interpersonal skills; demonstrate a strong orientation in customer service / satisfaction and ability to interact with physicians and high-level decision makers.
  • Substantive knowledge of managed care policies.
  • Knowledge of ICD-9, CPT, DRG and HCPC codes.
  • Knowledge of governmental products, contract language and reimbursement negotiations. 
  • Working knowledge of healthcare regulations including HIPAA, JCAHO, CMS, NCQA, URAQ.  
  • Flexibility, adaptability, creativity, initiative, teamwork skills, prioritization skills  
  • Proficient with Microsoft Office, strong typing skills. 

FULL TIME POSITION - SALARY COMMENSURATE WITH EXPERIENCE

 

To apply, e-mail resume to hr@ehsppo.com or fax resume to EHS at 727-938-2880. Please be sure to reference the title of the position you are applying for when sending your resume.

 

 

 

 

 

Job Title:  Network Contracting Team Leader

 

The Network Contracting Team Leader is responsible for the development and oversight of all PPO network product lines including Medicaid/Medicare, Commercial Health, Worker’s Compensation and International Health plans. Reporting to the COO, the Team leader will manage the overall direction of the network development staff. We are looking for a creative, take charge individual who works well in a fast-paced, growth oriented environment. Experience building national or regional networks is a must. The position carries broad responsibility for leadership and management both internally and externally within the contracted delivery system for all product lines.

 

Essential Responsibilities:

 

  • Develop contracting policies and procedures that support the business needs while promoting efficient decision-making, communication, compliance, and audit practices.
  • Analyze and use data to develop strategies for contracting and re-contracting including geo-access network reporting to ensure compliance with government requirements.
  • Train and manage a diverse team of healthcare professionals and clearly communicate with providers, clients, staff and senior directors.
  • Oversee credentialing and proper documentation along mandated guidelines.
  • Recruiting and negotiating contracts with hospitals, physicians and other medical provider groups.
  • Interface with all other departments to ensure accurate and appropriate configuration of contracts, database maintenance, provider recoveries, reimbursement rates, benefits configuration, project management, etc.
  • Develop and generate appropriate reports.
  • Perform other duties as required.

Job Requirements:

 

  • Minimum 5 years of healthcare related experience; at least three of which show proven success in the recruitment of medical providers to Medicaid and group health networks.
  • Strong leadership and management interpersonal skills.
  • Possess excellent organizational, oral and written communication, problem solving and quality control.
  • Demonstrate a strong orientation in customer service / satisfaction. Able to interact with physicians and high-level decision makers while managing diverse priorities.
  • Specific areas of expertise include governmental products, contract language and reimbursement negotiations, project planning and management, provider relations, network expansion.
  • Working knowledge of healthcare regulations including HIPAA, JCAHO, CMS, NCQA, URAQ.
  • Flexibility, adaptability, creativity, initiative, teamwork skills, prioritization skills
  • Proficient with Microsoft Office, strong typing skills. 

FULL TIME POSITION - SALARY COMMENSURATE WITH EXPERIENCE

 

To apply, e-mail resume to hr@ehsppo.com or fax resume to EHS at 727-938-2880. Please be sure to reference the title of the position you are applying for when sending your resume.