Provider Contract Specialist

One Call Medical, Inc., (OCM) is a premier outsourcing organization servicing the Workers' Compensation industry, providing the highest quality of scheduling service through its national network of credentialized providers.



We are currently seeking a Provder Contract Specialist. This candidate will identify and recruit potential providers for network participation for all OCM product lines. Assess the need for additional providers in a marketplace. Perform appropriate analysis and re-contract to optimize margin and performance in all territories.



ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

* Identify and recruit potential providers for network participation. Development of ongoing sources of new and existing providers and getting OCM on appropriate mailing lists to obtain this information.

* Conduct research on the Internet and other sources to develop appropriate leads for network development in all states assigned.

* Compose appropriate written material and correspondence in order to effectively communicate with potential providers.

* Negotiate contracts in person or via telephone with potential providers, reviewing proposed language and rates.

* Keep abreast of fees and requirements offered by competing networks to ensure our competitive status/advantage.

* Keep abreast of the provider and managed care marketplace in states of responsibility including items such as workers' compensation laws, Certificate of Need regulations, etc.

* Keep abreast of changing fee schedules, U.C.R., and Medicare Rates within your territory and its impact on provider contracting strategy.

* Analyze appropriate fee schedules and other sources of data in developing pricing strategies.

* Initiate opportunities to recontract with providers in order to maximize the margin.

* Initiate initial CACTUS setup when first beginning the contracting process with a potential provider in order for Specialty Contracting to access this information and to have it available in reports and queries.

* Maintain the CACTUS Database by keeping the Development Status updated throughout the recruitment process.

* Maintain relationship with sales staff in order to better meet the development needs of OCM clients. Participate in ongoing meetings between Sales and Development Departments.

* Assess need for additional contracted providers according to location, rates, equipment and compliance for referral volume.

* Initiate pricing library setup with Data Management and assign pricing library once created by Data Management.

* Develop network closure criteria in marketplaces where OCM may consider not accepting applications for new centers.

* Respond to inquiries from providers regarding referral patterns at their center.

* Initiate contracting efforts with providers nominated by Sales Department and follow up with Sales regarding the status.

* Perform initial feasibility studies on selected states to assess potential contracting environment.

* Communicate with the appropriate Provider Relations Specialist regarding zip coding of newly contracted providers in accordance with department objectives.

* Monitor operating margins in states through the Margin Reports available and initiate appropriate steps to improve.

* Maintain close communication with the Specialty Contracting Staff regarding areas where access issues have been identified.

* Utilize the Out Of Network Volume Reports as a way to identify high volume non-contracted providers and take the necessary steps to bring them into the network.

* Overnight and day travel as dictated by department needs and objectives.

* Maintain relationships with selected large corporate providers as assigned.

* Keep abreast of new technology and its potential impact on provider selection and recruitment.

* Communicate with Sales & Marketing Department regarding potential and newly recruited providers on an ongoing basis.

* Keep the Development Status in the CACTUS Database up to date in order for queries and reports to be accurate.

* Prepare and submit status reports and analysis as required.

* Maintain records on all providers contacted including, proposals sent, those that became contracted, those in the Credentialing stage, and those that chose not to do business with OCM.

* Provide project leadership on departmental projects as assigned.

* Contribute to the positive environment of the team.

* Must be computer literate with experience in a Microsoft Windows environment with a proficiency in Word and Excel.

* Must have strong oral and written communication skills.

* Must have strong organizational skills to ensure tasks are completed in a timely manner.

* Must be able to work independently and across the organization to make appropriate decisions.

* Must be able to clearly articulate the benefits and requirements of participating in OCM's provider network and be firm yet fair in dealing with non-compliant providers.

* Must have the ability to negotiate win-win relationships.

* Must have the ability to work in a fast paced, continuously changing environment with demanding turnaround times.

* Must have the ability to use various Internet search engines for required inquiries.

* Must be knowledgeable of various provider types, i.e., hospital, ancillary and physicians.

* Must have ability to learn and use new software as required.

* Must have the ability to work on several projects simultaneously.

* Must have the ability to work after hours and weekends if necessary.

* Ability to work from work site or home on a needed basis.

 

If interested, please submit cover letter with salary requirements to the email address listed. EOE.