Job Title: Network Contract Recruiter
100% remote - Preference given to candidates in EST Time Zone
Work hours: Monday - Friday, 8:00 AM - 5:00 PM EST
Job Description: The Network Contract Recruiter will perform targeted recruitment to close network adequacy gaps for Medicare / Medicaid on behalf of a managed care organization.
Must have experience contracting and negotiating provider contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
Evaluates provider network and implements strategic plans with the goal of meeting network adequacy standards.
Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital, and ancillary providers.
Must Have Skills:
Network development / contracting experience in managed care
Recruiting experience for health plans / closing for network adequacy
Staying within PADU contracting guidelines
Recruiting for Medicaid / Medicare
Ability to update spreadsheets / word templates
Day-to-Day Responsibilities:
Make outbound calls and send emails following up on targeted providers for closing network gaps related to network adequacy.
Work with business analysts and network directors to ensure timely application submissions for HSD filing for CMS approval.
Complete the exception request template with necessary data elements from CMS.
Required Years of Experience:
5-7 years contract-related experience in the healthcare field, including but not limited to provider’s office, managed care organization, or other healthcare environment.
3+ years experience in provider contract negotiations in a managed healthcare setting, ideally in negotiating different provider contract types, such as physician, group, and hospital contracting.
Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to Value-Based Payment, fee-for-service, capitation, and various forms of risk, ASO, etc.
Required Licensure / Education:
Bachelor’s Degree in a healthcare-related field or an equivalent combination of education and experience.