POSITION SUMMARY

The Provider Network Contract Specialist is responsible for the drafting and maintenance of provider and facility contracts for Health First Health Plans (the Health Plan) to ensure they meet the requirements of the Health Plan and applicable regulatory agencies together with supporting the network adequacy function of the Health Plan’s Provider Network Operations (PNO) department.

PRIMARY ACCOUNTABILITIES

1. Work with internal partners to ensure that contracts and contract language comply with government and regulatory agencies.
2. Manage database of provider contracts and maintain a tracking system for pending contracts.
3. Conduct research on provider contracts as needed.
4. Assure contracts are appropriately routed and approved in accordance with Health First policy.
5. Maintain and develop a catalog of electronic contract templates and prepare new and amended contracts based on established templates.
6. Prepares reports as needed or directed.
7. Conducts and participates in internal meetings.
8. Conduct outreach to secure new contracts with potential providers and facilities as needed and in support of the Health Plan’s expansion efforts.
9. Respond to audits related to provider contracts.
   10. Support provider term letter, geo access, and credentialing processes as needed.

MINIMUM QUALIFICATIONS

• Education: Associate degree in health care administration, legal studies or related field.
• Licensure: None required
• Certification: None required
• Work Experience: Three (3) years of health care and/or legal experience.
• Work Experience in lieu of Education: None

• Knowledge/Skills/Abilities: o Exceptional interpersonal communication and organizational skills. o Excellent organizational skills. o Ability to work autonomously, prioritize, work on, and support multiple projects and tasks concurrently. o Highly developed oral and written communication skills. o Ability to maintain confidentiality. o Advanced technical skills for use of MS Office (Excel, Word, Outlook and PowerPoint). o Strong time-management skills. o High degree of accuracy, efficiency and dependability. o Ability to apply logic and sound reasoning to determine facts, reveal root causes to timely decisions. o Possess data collection and quantitative decision-making skills.

  PREFERRED QUALIFICATIONS

• Education: Bachelor’s degree in health care administration, legal studies, or related field.

• Licensure: Paralegal.
• Certification: None
• Work Experience: No additional

• Knowledge/Skills/Abilities: No additional

  PHYSICAL REQUIREMENTS

• Majority of time involves sitting or standing; occasional walking, bending, stooping.

• Long periods of computer time or at workstation.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined; on site or remote.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Job: *Operations

Organization: *HF Administrative Plan Inc

Title: Provider Network Contracting Specialist - Provider Network Operations

Location: Florida - Brevard County-Rockledge

Requisition ID: 074397