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SalaryKey Responsibilities:
- Responsible for ensuring that the language of all contracts is in compliance with all State, CMS, AHCA, and any other regulatory agency.
- Responsible for developing, administrating and negotiating Provider Agreements for Primary Care Physician Services, Medical Specialty Care Services, Ancillary Care Services and Hospital Services.
- Responsible for negotiation of settlement agreements for all providers.
- Responsible for all limited or interim agreements of non-participating providers.
- Performs analysis to determine the needs of the existing networks
- Determining the forms of payment, i.e., capitation, FFS or trade agreements depending on financial impact.
- Ensuring that the networks are cost effective, marketable, stable, and offer broad access to members.
- Responsible for negotiating amendments to contracts
- Responsible for overseeing the provider data base system
- Responsible for performing claims and utilization research for re contracting existing network providers
- Comparative analysis of potential providers.
- Responsible for maintaining Contract Library.
- Responsible for overseeing the processing of all contracts.
- Responsible for ensuring accuracy of the provider database and provider directory.
- Responsible for developing and coaching the Network Development Department, Contract administration Department and Contract Library.
- Performs 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
- BS/BA Degree and 4 to 6 years of work experience in the health administration field with progressively more responsible Health Care Administration experience with strong preference for managed care experience.
- A minimum of 4 years in a leadership role
- 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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