York Risk Services Contract Specialist in Houston, Texas

Job Description

JOB SUMMARY:

To build and maintain a comprehensive network of providers for the purpose of servicing client needs, to foster and maintain relationships with participating and nonparticipating providers for the purpose of maintaining and increasing network penetration, and to negotiate one-time utilization agreements. Successfully negotiate provider agreements to provide meaningful value for our clients/customers, which in turn, offer greater coverage and savings to the network. Create data reporting and manipulation to identify target providers for successful contracting.

ESSENTIAL JOB RESPONSIBILITIES:

  • Contract successful # of provider agreements on a monthly basis that meet program guidelines.
  • Ensure statutory, regulatory and contractual compliance is obtained through established workflow processes.
  • Capture timely and measureable savings for Out of Network referrals and claims.
  • Ensure best possible coverage for optimal network penetration.
  • Assist in the required certified network audits, filings and due diligence necessary to successfully maintain good standing with the various certified states.
  • Develop & foster relationships with healthcare providers who have been identified by clients / customers, network services and/or state agencies as desirable and beneficial to the further expansion of the network for successful contracting.
  • Compliance with Company Policies & Procedures.
  • Perform all aspects of the job in an accurate and highly motivated fashion.
  • Consistently achieve or exceed established performance and results standards for the essential functions and responsibilities of the position.
  • Prioritize and organize assigned work.
  • Communicate to management any workflow problems, issues or backlog immediately.
  • Pursue personal and professional development.
  • Continually foster a teamwork spirit.
  • Maintain a neat working environment.
  • Assist with special projects and assignments as necessary, based on contracting and growth needs.
  • Maintain a professional image of the company, including professional appearance and attitude.
  • Perform other duties as assigned by immediate supervisor and/or department head. Required Skills

SKILLS/ABILITIES:

  • Excellent written and verbal communication skills.
  • Must have strong negotiating skills experienced with contracting healthcare providers.
  • Excellent customer service skills.
  • Must have a strong desire for professional growth.

KNOWLEDGE:

  • Basic knowledge of workers compensation and auto and general liability a plus
  • Basic knowledge of diagnostic procedures and diagnosis
  • Advanced experience with Microsoft Excel, data manipulation and anomaly detection
  • Demonstrated ability to work in a team environment Required Experience

EDUCATION:

  • BS / BA or equivalent work experience

EXPERIENCE:

  • 3 years of network experience in a managed care or healthcare environment
  • Prior contracting experience desired

Tracking Code: HOUSTON05191701

Job Location: Houston, Texas, United States

Position Type: Full-Time/Regular