Responsibilties
- Performs completed staff work to ensure the availability of relevant, trusted healthcare and benefits physicians (e.g., data collection, preparing presentation materials, and reviewing/evaluating applications and submitted documentary requirements).
- Negotiates contracts that comply with industry regulations while applying risk-minimizing techniques.
- Initiates collaboration with other Maxicare divisions/departments to identify and pursue better provider networks.
- Negotiates terms and conditions of contracts with physicians, ensuring alignment with organizational objectives and regulatory requirements.
- Provides inputs and ensures the drafting, reviewing, and finalization of contracts.
- Serves as the primary point of contact for contract-related inquiries and issues.
- Collaborates cross-functionally with internal divisions (e.g., Legal, Finance, Operations, Provider Network Management) to ensure seamless contract execution and alignment with organizational objectives.
- Conducts monitoring and regular visits to the Preferred Physician Network and other affiliated physicians to resolve relevant issues raised by internal and external stakeholders.
- Completes performance evaluation reports and communicates the performance evaluation results.
- Serves as the primary point of contact for physician inquiries and resolves concerns regarding claims submission, payment, contract renewal, and updates on Maxicare medically-relevant policies and guidelines.
- Implements appropriate physician development strategies to foster a culture of collaboration, continuous improvement, and shared success.
- Resolves cases of delayed discharge due to physician excess fees and maintains visibility and escalations for balance billing.
Qualifications:
- Bachelor's Degree in Business Administration, Healthcare Administration, Nursing, Public Health, Mass Communication, Marketing, or a related field.
- Professional Background: At least 2 to 3+ years of experience in healthcare operations, provider relations, client management, or contract management.
- Industry Experience: Direct work experience within an HMO, Health Insurance, Hospital Administration, or Healthcare Delivery setting is strongly preferred.
Leadership Experience: Experience acting as an individual contributor with project lead responsibilities, or basic team lead/supervisory experience (given the Supervisor level).
