Business Development Specialist

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Job description

The Market Provider Contractor Specialist will develop provider networks that are cost effective and offer an appropriate distribution of provider specialties. Establish and maintain strong business relationships with assigned providers and internal partners. Research provider network footprint based on need and evaluate for gaps. Contractor will be familiar with the various reimbursement methodologies (RBRVS, DRG's, OPPS, etc.) and medical claims.

Responsibilities

• Work with market leadership and corporate development to evaluate, build and contract with providers assigned to the geographic region
• Manage the financial performance of the network through models that are consistent with the rate goals of the company
• Understand the provider network landscape through various means, to develop an awareness of market intelligence
• Work within the department to develop a manual for contracting and provider education
• Understand provider contracts, and be able to explain and negotiate the rates and language that is in line with the PADU
• Attend industry organization meetings and physician networking events which occur outside of regular business hours.
• Track performance, report metrics and deliver on quarterly and annual growth targets
• Assist with credentialing activities as needed
• Meet contracting goals as assigned by the leadership team
• Track activities in salesforce or some other contract management software
• Continue professional growth and development
• Complete deliverables in a timely fashion
• Generate call and visit reports daily and document all provider encounters
• Preparation of agendas
• Attending offsite meetings
• Other duties as assigned

Qualifications

• Bachelor's degree required, masters preferred (MHA or MBA), or equivalent years of experience or Health Care Administration and/or Managed Care Organization or related field. Formal training in Provider Relations is a plus.
• 5 years related experience and/or training or experience/education.
• History of delivering sales performance and the ability to generate and own pipeline from development through execution.
• Managed care experience (2 years) or 4 years work experience in a provider office environment.
• Knowledge of healthcare industry - Health Plan, MSO, CMS, Federal regulations and downstream Medicare Advantage risk arrangements.
• Ability to manipulate large databases and to produce meaningful analytical and management reports.
• Ability to perform complex problem solving.