Job description

Provider Contracting Specialist

901 Market St, Philadelphia, PA 19107, USA Req #1502

Monday, May 1, 2023

Why Choose Health Partners Plans?

We are an award-winning, not-for-profit health maintenance organization serving Pennsylvania residents.

We offer Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We’re also committed to boosting the health of our community through outreach, education, and events. Founded over 35 years ago, Health Partners Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care.

We are committed to creating a community where everyone belongs, acknowledges and celebrates diversity and has opportunities to grow into their fullest potential.

Perks of HPP and why you will love it here:

• Competitive Compensation Packages including 401(k) Savings Plan with Company Match and Profit Sharing
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off
• Diversity & Inclusion commitment
• Impact on the communities we service

We are hiring a Provider Contracting Specialist to join our team remotely!

Under the direction of Manager, develops and maintains cost effective contracts for physicians, facilities, and ancillary providers. Provider Contract Specialist participates in contracting processes, with goal of maximizing provider’s overall satisfaction with Health Partners. Lead and manage meetings with all providers as assigned by Manager. Identify and recruit new providers into network as assigned by Manager.

As the Provider Contracting Specialist your daily duties may include…

• Able to work in a constant state of alertness and safe manner
• Recruit, develop and maintain cost effective provider networks for all assigned lines of business. Includes recruitment, recommending pricing, analyzing proposals, negotiating, and contracting new providers.
• On an on-going basis, review adequacy and accessibility of assigned provider network.
• Develop and maintain positive relationships with assigned provider network.
• Manage, research, and respond to internal provider inquiries.
• Manage and administer contracts and contract amendments. Review and recommend, rate proposals. Participate in rate and language negotiations/discussions,
• Work with other departments to implement new contracts, and changes to existing contracts, both accurately and on a timely basis.
• Ensure that contract effective dates are properly managed to facilitate timely rate updates, contract approvals and implementations.
• Calculate scheduled rate increases and obtain provider concurrence.
• Accurate verification and maintenance of provider information for provider data integrity in all databases, MA revalidation and directory production,
• Manage non par negotiations.
• Ensure agreements are compliant with legal, regulatory, accreditation and other business requirements.
• In conjunction with Provider Reimbursement area, analyze cost impact of proposed or scheduled rate increases
• Manage, research, and respond to all provider inquiries requiring contract interpretation.
• Manage projects for assigned providers, in conjunction with the Claims department, conduct preliminary research to determine any obvious root causes and potential resolutions for all contracting, claims, and policy and procedures issues and inquiries.
• Timely coordination and management of all internal meetings required to resolve provider issues.
• Field and resolve business unit concerns about provider contracts.
• Respond to inquiries and provide guidance to new and existing HPP staff on Contracting and topics.
• Serve as departmental representative/participant on interdepartmental and external work groups/task forces as assigned.
• May perform other duties as assigned

Qualifications and Skills, We Value

• List Qualification and skills
• Bachelor’s Degree or equivalent work experience in Business, Healthcare, or related Liberal Arts discipline, with coursework in Health Care preferred.
• Work experience may be substituted for specific Health Care related coursework.
• 3-5 years of experience in a managed care setting (payer or provider based), with exposure to provider reimbursement; experience with provider recruitment, contracting customer service and claims payment preferred.
• Prior experience with a Medicaid and Commercial health plans preferred, but not required.
• Superior organization, personal interaction, and follow-up skills required.
• Excellent written and oral communication skills required.
• Strong quantitative analytic abilities preferred.
• Careful attention to detail required.
• Ability to represent Health partners independently with external providers preferred.
• Intermediate to advanced use of Microsoft Excel and Word, knowledge of provider payment methodologies, including case based, per diem, etc., sufficient to analyze cost experience preferred.
• Familiarity with claims payments processes preferred.
• Knowledge of Microsoft Access desirable (Microsoft applications)

HPP is a nationally recognized company for their innovations in care, Health Partners Plans is more than your average health care company and can help you achieve your career goals

Job Type: Full-time

Pay: $55,000.00 - $70,000.00 per year

Benefits:

• 401(k)
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Remote

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