Provider Network Specialist jobs in Battle Creek, MI
Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Provider Network Specialist jobs
- Corewell Health
-
Southfield, MI
FULL_TIME
-
Job SummaryWith some supervision, acts as the key contact and subject matter expert for assigned contract-related activities. This includes developing and negotiation contract terms, conditions, modifications, penalties and incentives, while working with key stakeholders to ensure that their requirements are met. Analyzes and evaluates change to drive continuous improvement in the process of contract management and contract mamangment trends. Additionally, this position manages the contract execution process; resolving problems, mitigating delays, mediating disputes and escalation issues. Specialists at this level are competent to work in most areas of contract area, but may require guidance in others.Essential Functions
- Contributes to the contract development and negotiation process for provider network initiatives. Enters/maintains current information in the internal contract repository and enters contracts and contract information in the system contract database.
- Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters. Renegotiate contracts within specific provider types under predetermined payment parameters.
- Manages contract review process to ensure delivery against objectives and contractual budgets; develops regular reports on contract milestones and performance; and informs internal customers, suppliers and management of activities and progress, through both verbal and written communications. With manual supervision acts as the principle contract negotiator for all assigned contracts.
- May support management in codifying contract terms for more complex contracts. Identifies barriers and opportunities in contracting with ability to articulate these obstacles to management for support as needed.
- Works with and involves relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements, contract standards, cost targets and payment and pricing methodologies. Facilitate contract implementation processes with the PIM team including payment rates, PFP/PHO groupings, risk pool assignment, administration and other feels. Work collaboratively with PIM and others internal staff to find solutions to provider issues concerning payment and operating procedures with necessary.
- May be responsible for implementation of network expansion plans and individual physician recruitment within an assigned geographic area.
- Creates a customer-focused, service-based approach to working with stakeholders and suppliers, which emphasizes the creation and cultivation of cross-organizational relationship.
- May represent contracting and external meetings and Joint Operating Committee meetings. Interface routinely with physician practices managers and group administrators.
Qualifications- Required Bachelor's Degree or equivalent
- 2 years of relevant experience related field Required
- 5 years of relevant experience negotiating and managing contract lifecycles on behalf of either their part payer or health care providers Required
- knowledge of CMS and commercial pricing practices and methodologies Preferred
- Knowledge of best practices for contract negotiation tactics and strategies Preferred
- Working knowledge of anti-trust laws preferred
- Provider reimbursement experience preferred
- Contract and negotiations experience preferred
Physical Demands- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 10 lbs
- Pulling Force > 5 lbs: Seldom up to 10 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Occasionally
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
Primary Location
SITE - American Center - 27777 Franklin Rd - SouthfieldDepartment Name
PH - Provider ContractingEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8 a.m. to 5 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
- 8 Days Ago
- Lucid Hearing
-
Battle Creek, MI
FULL_TIME
- Job Description Hearing Instrument Specialist / Audiologist Sam’s Club Battle Creek, MI, USA Full-time: Tues-Sat & M-F Rotating Position: Specialist (HIS or AuD) Job Description Our Mission: "Helping ...
- 1 Month Ago
- Oaklawn Hospital
-
Marshall, MI
FULL_TIME
- Job Summary: Designs, implements and supports the network, compute and storage infrastructure. This position contributes to development of standards for installations, performance monitoring, and data...
- 5 Days Ago
- Oaklawn Hospital
-
Marshall, MI
FULL_TIME
- Job Summary: Designs, implements and supports the network, compute and storage infrastructure. This position contributes to development of standards for installations, performance monitoring, and data...
- 5 Days Ago
- Opportunities
-
Hastings, MI
FULL_TIME
- Hastings Mutual is currently lookin for a Senior Network Analyst to join our IT Infrastructure and Operations team! This is a great opportunity for an experienced IT/Network professional to play a vit...
- 13 Days Ago
- Spring Arbor University
-
Spring, MI
FULL_TIME
- SUMMARY SAU IT is looking for someone to join our team that is willing to serve in a broad capacity both with technical skills and with customer service skills. Responsibilities include managing aspec...
- 13 Days Ago
- Current Active Filter
- Battle Creek, MI
Clear All
- Filter Jobs By posted time
- Within 1 Day
- Within 2-7
- Within 1 Month
- Within 3 Months
0 Provider Network Specialist jobs found in Battle Creek, MI area
- The Calhoun County Online Application Consortium
-
Marshall, MI
- Position Type: Technology/Computer Technician Date Posted: 4/19/2024 Location: Marshall Public School District Date Avai...
- 4/24/2024 12:00:00 AM
- Avance Consulting
-
Kalamazoo, MI
- Job Description Job Description Infoblox deployment, setup, troubleshooting, supportComplex routing and switchingFirewal...
- 4/23/2024 12:00:00 AM
- Re:Build Manufacturing
-
Kalamazoo, MI
- About Re:Build Manufacturing Re:Build Manufacturing is a rapidly growing family of industrial businesses combining enabl...
- 4/23/2024 12:00:00 AM
- Sawdey Solution Services
-
Battle Creek, MI
- Category Information Technology Description The Telecommunications Network Engineer - Senior analyzes and develops telec...
- 4/22/2024 12:00:00 AM
- Infor
-
Marshall, MI
- Healthcare Professionals (HCP) compliance with necessary vaccinations ensures the uninterrupted operational continuity o...
- 4/22/2024 12:00:00 AM
- Kingscott Associates
-
Kalamazoo, MI
- The IT Help Desk Coordinator / Technician plays a crucial role in providing technical support and assistance to end-user...
- 4/22/2024 12:00:00 AM
- Stryker
-
Portage, MI
- Work Flexibility: Remote or Hybrid or Onsite As the Associate Manager, Customer Intelligence, you will manage the delive...
- 4/21/2024 12:00:00 AM
- Wideopenwest
-
Potterville, MI
- Job Description WOW! offers a Competitive starting wage + Stock Grant + Incentives + Excellent Benefits Package How else...
- 4/21/2024 12:00:00 AM
About Battle Creek, Michigan
were up 1.3% from a year ago