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$60k–$63k/yr
Full-time
bachelor degree
Posted 10d ago
~40 hrs/week
Responsibilities
The Healthcare Contracting Specialist manages physician contracting and network development to meet market growth and medical cost targets. They are responsible for negotiating provider contracts, maintaining network relationships, and ensuring compliance with company standards.
Requirements
Candidates must have a bachelor's degree or equivalent experience in network development or provider relations. A minimum of three years of experience in Medicaid/Medicare is preferred, along with strong communication and technical skills.
Full job description
Description
Position Summary
Manages physician contracting and network development functions for developing, executing and maintaining a provider network strategy statewide. Works in concert with medical management and the Provider Servicing Department in developing actions to meet market growth and medical cost targets.
Duties and Responsibilities
Primary duty of negotiating and executing provider contracts.
Leads research for any Institution, Network and/or Ancillary needs using all tools available; including but not limited to: WebMD, Health Plan websites, hospitals, google, etc.
Provider networks contracting for initial network development and/or expansion in accordance with Company goals and standards.
Meet with the appropriate physician personnel and fully explain the Company’s protocol, which includes all requirements necessary to comply with standards identified in the Provider Manual.
Collects complete credentialing packets per specified health plan and according to the Networks Credentialing checklist from network physicians during the contracting process.
Ensures that the provider network consists of Board Certified/Board Eligible Specialists and/or Ancillary providers as contracted by the network.
Manages physician network by developing relationships to drive business results within assigned geographic area.
Liaison in conjunction with Contracting and Credentialing Coordinator, for all health plans on all new contracting inquiries.
Obtains leads for prospective physicians, manages all incoming new provider leads and follows-up with the providers on the status of their new contractual agreement per the Department’s Policies and Procedures.
Strategizes to close all quarterly assigned Geo Access deficiencies per specialty and health plan.
Special projects as assigned or directed.
Negotiating and executing hospital contracts.
Maintaining and updating current CRM platform (Monday.com) to reflect progress of ongoing leads negotiations.
Requirements
Travel
Yes, 95% of the time or as otherwise required by the company throughout the following Regions:
Region 6: Hardee, Highlands, Hillsborough, Manatee and Polk
Region 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota
Knowledge
A bachelor’s degree in a related field or equivalent experience related Network Development or Provider Relations experience.
Minimum three (3) years’ experience in Medicaid/Medicare is preferred.
Healthcare, provider office or HMO/PPO background preferred.
Strong knowledge of regulatory requirements concerning Medicare and Medicaid.
Skills
Excellent problem-solving skills.
Excellent oral and written communication skills.
Bilingual language skills a plus.
Intermediate or stronger skill level with MS Word, Excel, Outlook and PowerPoint.
Delivering Transformational Solutions to our Healthcare Partners serving the health care continuum.
Industry
Hospitals and Health Care
Company size
51-200 employees
Founded
1998
Headquarters
Miami, Florida
LinkedIn followers
6,506
Provider Network Solutions (PNS) is the market leader and innovator in Specialty MSO and Third-Party Administrative services, managing Governmental and Commercial lines of business to align Health Plans, Primary Care Physicians, and Specialists in a comprehensive ecosystem.
PNS optimizes the delivery of specialty healthcare, guided by advanced analytics and an NCQA Accredited UM Program while adhering to regulatory requirements and information systems security guidelines. Our Health Plan and Provider partners benefit from over 30 years of specialty risk management expertise.
PNS’s mission is to be the Premier Value-Based Specialty Ecosystem organization, which provides our Health Plan partners with a Specialty network of providers who ensure quality patient care through compassion while adhering to “Best Practice” guidelines. We strive to enhance our Specialists with greater access to patients seeking their service while maintaining complete data integrity and a robust security platform.
Our culture promotes an environment where individuality and diverse mindsets collaborate and inspire each other to be better. Our enthusiastic and invaluable team members are encouraged and empowered to create reliable top-drawer solutions, not only for our internal but for our external stakeholders as well.
Our core values and purpose-driven mindset fostering continuous and never-ending improvement, (C.A.N.I.) are evident and palpable throughout our organization and kept alive by our team. PNS is a company where you will be embraced by colleagues who want to see you grow in an environment that will inspire you to become the very best version of yourself.
For Career opportunities visit us at: https://www.providernetworksolutions.com/careers/
We are always eager to meet fresh talent. Here, at Provider Network Solutions, you’ll do more than join an organization— you’ll become part of the family. There is a place here for every kind of brilliant.
Offices: 3750 NW 87th Ave, Suite 500, Miami, Florida 33178, US
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How many Administrative jobs are open in Sarasota, FL right now?
There are currently 370 open administrative positions in Sarasota, FL listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Administrative roles in Sarasota, FL?
Companies currently hiring include Sarasota Memorial Health Care System, Marriott International Hotels, Inc., The Salvation Army, US Eye, Harmar, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Administrative jobs in Sarasota, FL?
Yes — 27 of the 370 open administrative positions offer remote or hybrid work (10 remote, 17 hybrid).
How do I apply for Administrative jobs in Sarasota, FL?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.