Evaluates assigned territories and negotiates contracts with physicians, specialists, ancillary providers and hospitals.
Essential Functions & Responsibilities
Target potential providers to establish contractual agreements.
Analyzes and evaluates assigned territories for recruitment needs
Recruits and contracts physicians, specialists, ancillary providers and hospitals for HN1 with inclusion of all necessary documentation, i.e. credentials, site visits.
Researches and solves any questions or concerns that providers may have.
Negotiates contracts for HN1 with inclusion of all necessary documentation, i.e. credentials.
Works with contracted providers to integrate their services into the overall care delivery network.
Maintain lines of communications with all internal departments and with all participating providers in enlisting their assistance in referring potential providers in the Network.
Organize reports for presentation to senior management staff.
Support other departments as needed.
Expedites and researches provider’s utilization data with reference to negotiating new rates.
Responsible for conducting site visits of all newly contracted providers.
Supports Credentialing Department by assisting with the collection of physician credentials for re-credentialing purposes.
Maintains and updates physician files.
Evaluates claim data on recently contracted providers, ensuring contract is profitable for Company.
Respond to provider inquiries regarding contracts, provider networks and HN1 operations.
Required Education and Experience
Associate's degree (A. A.) or equivalent from two-year college or technical school;
and two to three years’ experience in physician's office, HMO's or other Health Care institutions