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Provider Contracting Specialist

Company: Prime Health Services
Location: Franklin
Posted on: March 16, 2023

Job Description:

Prime Health Services (PHS) is a national medical cost containment company with a noteworthy PPO Network used by insurance carriers, TPA's, self-insureds, and governmental entities. Our tech-focused nature allows clients to take advantage of the flexibility of customization while not compromising on bill processing speed. Since 2001, we have specialized in medical provider network development and offer clients a tailored approach to medical cost containment: quality health care at discounted rates. The Provider Contracting Specialist is responsible for identifying, recruiting and contracting individual physicians, physician groups, ancillary facilities and other medical provider groups to join the PPO network. Negotiations will primarily be with physicians and physician groups with a focus on workers' compensation, commercial group health, auto liability and personal injury, with defined reimbursement expectations. Contracting efforts will be based primarily upon client nominations. This position requires successful recruitment of medical providers to join the PPO network. Additionally, this role requires skills to obtain contractual reimbursement rates contained within clearly defined parameters, per product, that meet or exceed industry expectations. Essential Job FunctionsNegotiate managed care PPO contracts, ensuring a cost effective contract in compliance with all State, provider, and corporate requirementsNegotiate PPO contracts with independent hospitals and health care systemsAnalyze data to develop strategies for contracting and re-contractingCall/email medical providers for contracting Develop and maintain relationships with key medical providers at the direction of the Director of Network DevelopmentEnter all progress reports and any notations regarding contracting efforts into Prime's proprietary databaseThe Provider Contracting Specialist may be asked to travel for PHS purposes. Travel will range from less than 20% to 50%, depending upon experience level and contracting assignments. All travel must be approved by the Director of Network Development

Bachelor's Degree in Communications/Business or related field of study from an accredited college or university, or equivalent experience requiredManaged care contracting experience preferredExperience working in a deadline driven environmentCompetenciesProfessional, friendly demeanorExcellent written and oral communication skillsFlexible, adaptable, creativeOrganized and self-motivated Must have strong problem solving skillsAbility to prioritize Must be willing to be collaborative and work well in team environment Strong customer service and public relations skillsStrong technical skills required, including Microsoft OfficePM21PI208064864

Keywords: Prime Health Services, Franklin , Provider Contracting Specialist, Other , Franklin, Tennessee

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