Reimbursement Specialist - Healthcare jobs in Tallahassee, FL

Job Summary:

The Network Development Representative focuses on building Specialty Benefits Networks across multiple Markets/States considering cost negotiations and adequacy to support expected membership volume by Levels of Service. The position will support the Specialty Benefits Networks with growth objectives and analytical analysis to ensure company strategies for expansion are adequate to meet contract demands for each respective Market/State. The position coordinates with Provider Leads to complete contracting with identified Specialty Benefit providers.

Duties:

· Target potential providers to establish contractual agreements.
· Thoroughly understand Alivi’s Corporate Playbook and always ensure alignment with the playbook in all day-to-day activities.
· Work directly with strategic leaders of the company to ensure strategic support for expansion efforts and ability to administer contract arrangements with Health · Plans/Payers in Medicare, Medicaid, and Commercial lines of business.
· Travel to provider offices as needed to secure Specialty Benefit provider contracts.
· Support Alivi’s business development, corporate growth strategy, and goals as needed.
· Recruit, negotiate, contract, and re-contract with Specialty Benefit providers at all ‘Levels of Service’ to ensure quality, cost-effectiveness, and participation in all products.
· Support contracting efforts for new products/risk strategies help develop new service areas and negotiate with new providers.
· Support in the development of strategic initiatives relating to provider networks, including service area expansions, new payment and incentive methods, risk arrangements, and new products.
· Work with the provider relations team to develop and maintain a comprehensive provider network (hospitals, physicians, ancillary) that meets CMS access standards and delivers a full range of healthcare services to our members.
· Analyze, plan, and ensure the provider network adequately meets all CMS access standards across all geographic areas.
· Communicate internally and externally regarding all provider-related issues. Participate in key committees throughout the organization.
· Act as a liaison between Alivi and contracted health plans concerning all aspects of Specialty Benefit provider network participation.
· Supports the Credentialing Department by assisting with the collection of physician credentials for newly contracted providers.

Experience:

· Associate degree preferred.
· 1 to 2 years experience with Specialty Benefit providers and downstream provider contracting.
· Knowledge of provider reimbursement strategies for Managed Care, government products, and commercial products.
· Must have a valid driver’s license.
· Must be able to pass DMV record check.

Note: This job description is intended to provide a general overview of the position. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required for the role.

Job Type: Full-time

Pay: Up to $75,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Paid time off
• Referral program
• Vision insurance

Application Question(s):

• Do you have knowledge of provider reimbursement strategies for managed care, government products and commercial products?
• Do you have a valid drivers license?
• Are you able to pass DMV record check?
• Please share your desired salary range.
• Are you able to travel to provider offices as needed to secure contracts within the North Florida panhandle area?

Experience:

• specialty providers: 1 year (Required)
• downstream provider contracting: 1 year (Required)

Language:

• Spanish (Required)

Ability to Relocate:

• Tallahassee, FL: Relocate before starting work (Required)

Work Location: On the road