Network Contracting Representative

  • Network Management
  • Fort Lauderdale, FL
  • 1 month ago
  • 1 available

Job Description

Responsible for developing, maintaining and supporting the day-to-day Specialty Provider Networks (SPN) contracting initiatives, which the respective individual manager for Health Network One, Eye Management, and/or Therapy Network (collaboratively referred to as “HN1”).      

Essential Functions & Responsibilities

  • Coordinate the prospecting calls to potential providers for inclusion in the targeted SPN, including the continued follow up and documentation.
  • Generate leads for SPN contracting via different methods, but not limited to: search engines, health plan directories, State Agency Provider lists, DOH license database and NPPES.
  • Coordinate the entire contracting process for all potential providers, including prospecting, negotiation and credentialing.
  • Collect all providers signed contracts, applications and necessary credentialing information, ensuring each State credentialing standard is maintained.
  • Support the activities of Network Development for the corresponding SPNs assigned, including: Provider Communications, Provider Outreached, Provider Contracting, Provider Education and Provider Services, among others.
  • Complete Provider Maintenance Forms (PMF), when needed, for Provider additions in the Network.
  • Maintain a close working relationship with the TPA operations staff and work interdependently with each Department: Claims; Utilization Management; IT; Credentialing; and Provider File Maintenance.
  • Advise Management of both strengths and weaknesses in the SPN and institute or recommend changes which better serve the organization and its assigned membership.
  • Act as a liaison between HN1 and key and/or high volume Providers with all relevant matters concerning contractual and financial terms as stated in Providers’ contract with HN1.
  • Provide and support network reporting requirements for SPN development and expansions.
  • Maintain familiarity with the managed care industry, such as availability of outside sources of information, statutes affecting HN1 business, current industry trends, and general services/locations of major non-contracted health plans and providers.
  • Participate and contribute in staff and committee meetings as requested by the Contracting Manager, Contracting Director, Sr. Director of Network Operations, VP of Network Operations, President and/or COO, including evening quarterly Executive Committee Meetings and Medical Advisory Committees (MAC).
  • Support company philosophies, objectives, decisions and policies.
  • Require adherence to department and organizational standards, policies and procedures including HIPAA.

Required Education and Experience

  • Five (5) or more years of contracting/development experience.
  • Five (5) years of extensive working background in the managed care industry