Provider Contractor Executive - Hybrid

Job Type

Full-time

Description

***NOT A REMOTE POSITION***

Hybrid: 4 days in office, 1 day from home

General Summary for a Provider Contractor Executive

The Provider Contractor Executive is responsible for identifying, recruiting, negotiating and contracting providers to join the Prime Health Services PPO network with a focus on workers' compensation, commercial group health, auto liability, and personal injury

Provider Contractor Executive Essential Job Functions

• Recruitment of Providers, ancillary facilities, hospitals and health systems 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
• Negotiates payment rates and payment terms for new and existing contracts within PHS corporate requirements including terms and conditions associated with State or Federal guidelines
• Successfully negotiates PPO contracts with large medical provider groups, independent hospitals, integrated care models, and health care systems
• Analyzes data to develop strategies for contracting and re-contracting
• Performs data analytics of proposed rates to ensure contracts for new and existing providers align with defined contracting guidelines
• Meets/exceeds daily call metrics, completion of negotiated contracts as defined by contracting leadership, which is subject to review and modification
• Manages and oversees assigned contracting tasks for specified geographic regions
• Ensures contract proposals are complete and accurate prior to sending information to the Provider for review and/or signature
• Establishes and maintains productive professional relationships with the Provider, hospitals, and health systems
• Enters progress reports and any notations regarding contracting efforts into PHS proprietary database
• Travel up to fifty percent (50%) may be required as needed to conduct stewardship meetings with Providers

Requirements

• Bachelor's Degree in Communications/Business or related field of study from an accredited college or university, or equivalent experience required
• Senior Level - 5+ years and Executive Level - 8+ years of managed care contract experience preferred
• Demonstrated negotiation skills and experience interfacing with C-Suite level contacts

Competencies of a Provider Contractor Executive

• Must be able to successfully work in a remote, collaborative, deadline driven work environment
• Professional, friendly demeanor with excellent written and oral communication skills
• Flexible, adaptable, creative, organized, and self-motivated
• Must have strong negotiations and problem-solving skills and the ability to prioritize
• Strong customer service, public relations, and technical skills required, including Microsoft Office

Benefits

• Medical Insurance (high deductible plan with an HSA)
• Dental Insurance
• Vision Insurance
• Short-term and long-term disability paid by the company
• Group term life paid by the company
• PTO - 160 hours (4 weeks) with the ability to roll over 40 hours and cash out 40 hours at the end of the year
• Fitbit program with monetary rewards
• Employee recognition programs with monetary rewards
• Corporate office amenities - specialty coffee machines, assorted tea options, smoothie bar, collaborative workspaces, fruit provide by company and an onsite market
• Regular 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 events

About Us

Prime 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.