MSLA is a Medical Corporation that provides comprehensive independent medical evaluations (IME) and other IME related services to the government and private industry. Our business philosophy incorporates both exceptional customer service and quality evaluations, both of which are the primary factors for our rapid growth since our inception in 1998. No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm) The Senior Network Development Recruiter role develops the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. The Senior Network Development Specialist (Recruiters) evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Important responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties. Primary Responsibilities: Apply basic knowledge of theories, practices and procedures in a function or skillPerform routine or structured workRespond to routine or standard requestsUse existing procedures and facts to solve routine problems or conduct routine analysesDepend on others for instruction, guidance or directionProvide operational support to multiple Network Development SpecialistsBalance financial and operational impact of contracts with providers when negotiating contract termsCommunicate contractual and/or operational performance to providers to ensure compliance with contractual terms and protocolsWeigh financial and operational information to evaluate continued provider participation or renegotiationDemonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changesSubmit demographic and contractual update requests for applicable provider types for assigned geographyIdentify and share best practices (payment methodologies in order to execute market strategies)Present and discuss industry and market trends with internal and/or external groups to improve network performance and retentionRepresent department in internal meetings to gather relevant information, present/recommend solutions, and provide updates on results/decision/activitiesManage annual contract related projectsReview and maintain network management tracking spreadsheets
Required Qualifications:3+ years or more experience in a network management recruitment related role, such as contracting or provider services. (healthcare provider recruitment) 1 year or more in-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS) 2+ years of experience in pricing and fee schedule development using actuarial models 2+ years of experience utilizing financial models and analysis in negotiating rates with providers year or more intermediate level of knowledge of claims processing systems and guidelines 2+ years of experience in performing network adequacy analysis Bachelor's degree or equivalent plus experience Ability to travel around 50% of the time in specified territory based in the Central Midwest region, Southeast and Northeast (States where travel is expected are currently listed as: ND, SD, NE, KS, MO, IA, MN, WI, IL, IN, MI, KY, TN, MS, PA, OH, AL, GA, NY,CT, PA, NJ, NC, SC, MD Washington DC, VA, West VA, MA, ME, NH, VT, RI) *Please note territories may shift and change due to business reasonsPreferred Qualifications: Veteran's Benefit Healthcare experience highly desired Niche industry background with Government and V.A. Experience in fee schedule development using actuarial models Experience utilizing financial models and analysis in negotiating rates with providers MS Excel experience Experience in performing network adequacy analysis Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others Strong interpersonal skills, establishing rapport and working well with others Strong customer service skills NDB, NICE, COSMOS, Facets (internal employees only)If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five yearsCareers with MSLA. Our focus is simple. We're innovators at providing technology - driven, comprehensive, independent medical evaluations to government and private entities. In addition to our core clinics located throughout California, Nevada and Hawaii, we manage an extensive nationwide network of fully credentialed physicians in all major specialties. We've joined Optum, part of the UnitedHealth Group family of businesses. And when you join our team, you'll impact the lives of others by verifying the validity of claims, providing quality examinations and meeting the timelines that make a difference for our customers. Here, you'll join a team that makes you want to do better every day, resulting in your life's best work.(sm) https://www.mslaca.com/ Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: VES, Veteran Benefits, Healthcare, Provider Network Development, Provider Network Recruitment, Contract Negotiation, Fee and pricing negotiation, Tampa, FL, Florida, ND, SD, NE, KS, MO, IA, MN, WI, IL, IN, MI, KY, TN, MS, PA, OH, AL, GA
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.