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Doctors Healthcare Plans
Healthcare Network Development SpecialistDoctors Healthcare Plans • Miami, FL, United States
Healthcare Network Development Specialist

Healthcare Network Development Specialist

Doctors Healthcare Plans • Miami, FL, United States
1 day ago
Job type
  • Full-time
Job description

Network Development Manager

Job Purpose: This position is responsible for all activities related to developing, maintaining and expanding the network of providers, including development, administration and negotiation of physician, medical group, ancillary, hospital and vendor agreements in compliance with all regulatory state and federal guidelines.

Responsibilities:

  • Ensuring that the language of all contracts is in compliance with all State, CMS, AHCA, and any other regulatory agency.
  • Utilizing only company approved Provider Agreements.
  • Obtaining all credential information for new providers and facilities and ensuring completeness and current information is provided.
  • Ensuring completeness of all information in the agreements.
  • Negotiating Provider Agreements for Primary Care Physician Services, Medical Specialty Care Services, Ancillary Care Services and Hospital Services.
  • Negotiating agreements for all providers.
  • Performing analysis to determine the needs of the existing networks.
  • Determining the forms of payment, i.e., capitation, FFS or trade agreements depending on financial parameters established by the Network Development Department.
  • Negotiating amendments to contracts.
  • Assisting in maintaining the integrity of the provider database system as it relates to contracts.
  • Performing claims and utilization research for re contracting existing network providers.
  • Comparative analysis of potential providers.
  • Responsible for departmental projects as requested and needed.
  • Performing other job related duties as assigned from time to time by the VP Network Development and/or President/CEO.

Qualifications:

  • Excellent negotiation skills.
  • Excellent oral and written communication skills.
  • Bilingual English/Spanish preferred.
  • Bachelor's degree in health services administration, business or related field of study or an equivalent combination of training and experience.
  • Demonstrates a broad-scope of financial knowledge.
  • Knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines.
  • Excellent organizational and customer skills.
  • Versatility.
  • Excellent customer skills.
  • Ability to work well under pressure and difficult situations.
  • Capable of managing a variety of complex issues while driving momentum of key initiatives.
  • Excellent knowledge and management of risk relationships.

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted.

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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Healthcare Network Development Specialist • Miami, FL, United States

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