Provider Contractor - Specialist

Description:A high number of candidates may make applications for this position, so make sure to send your CV and application through as soon as possible.***NOT A REMOTE POSITION***DescriptionThe Provider Contractor Specialist is responsible for identifying, recruiting, and negotiating contracts with individual physicians, provider groups, ancillary facilities, and other medical provider groups to join the Prime Health Services PPO network. The contracting process includes negotiations focused on workers' compensation, commercial group health, auto liability, and personal injury. This position reports to the VP of Network Development.Essential Job FunctionsRecruits Providers via phone, email, or mail campaigns to negotiate PPO contracts for PHS Core business initiatives; ensuring contracts are cost effective and in compliance with all State, Federal, and corporate requirements,Recruits and manages Specialty Network builds and Special Projects as assigned for PHS Clients via Client NominationsNegotiates payment rates and payment terms for new and existing contracts within PHS corporate requirements including terms and conditions associated with State or Federal guidelinesPerforms data analytics of proposed rates to ensure contracts for new and existing Providers align with defined contracting guidelinesMeets/exceeds daily call metrics, completion of negotiated contracts as defined by contracting leadership, which is subject to review and modificationManages and oversees assigned contracting tasks for specified geographic regionsEnsures contract proposals are complete and accurate prior to sending information to the Provider for review and/or signatureSubmits contractual language reviews to VP of Network Development for review and approvalEnsures contracts for execution are complete, accurate, and all applicable documentation is present prior to submission to VP of Network DevelopmentEstablishes and maintains productive professional relationships with the provider communityResolves escalated contract specific issues of Providers and ClientsEnters progress reports and notations regarding contracting efforts into PHS proprietary databaseTravel may be required as needed to conduct stewardship meetings with ProvidersRequirements: Bachelor's Degree in Communications/Business or healthcare related field of study from an accredited college or university, or equivalent experience required1 + year(s) of experience in managed care contracting and/or healthcare is requiredCompetenciesExcellent communication (written and oral), problem solving, and time management skills,Experience working in a collaborative, team spirited, and deadline driven environment,Must be flexible, adaptable, creative, and self-motivated (initiative),Demonstrate strong customer service and public relations skills,Demonstrated technical skills proficiency, including Microsoft Office Suite,BenefitsMedical Insurance (high deductible plan with an HSA)Dental Insurance Vision Insurance Short-term and long-term disability paid by the companyGroup term life paid by the companyPTO - 160 hours (4 weeks) with the ability to roll over 40 hours and cash out 40 hours at the end of the yearFitbit program with monetary rewardsEmployee recognition programs with monetary rewardsCorporate office amenities - specialty coffee machines, assorted tea options, smoothie bar, collaborative workspaces, fruit provide by company and an onsite marketRegular employee events such as potlucks, video game tournaments, door decorating contests, Mental Health Awareness Month activities, and a company carnival just to name a few of our past eventsAbout UsPrime 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.PI6666c7bb528f-37344-38564198

Created: 2025-10-01