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- Develop and implement provider network and contract strategies, identify medical and dental providers in lacking geographic locations to establish a sufficient network of participating providers to serve our clients.
- Execute and review provider contracts, reimbursement rates, updates, and terminations received to ensure documents are accurate and complete before submitting them for processing
- Enhance provider relationships by researching and resolving provider-related matters and effectively handling and responding to account changes and correspondence.
- Participate in audits of provider directory data to ensure accuracy of the information.
- Lead efforts for credentialing providers and report credentialing activity on an ongoing basis through company provided software applications.
- Oversee the maintenance of all Provider contract information for given territory. Work with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
- Seek, contact and negotiate single case or prepay agreements to fulfill gaps in contracted provider coverage as needed for the business.
- Convert prepay providers to net terms as applicable.
- Develop relationships with providers and offers feedback if there are deficiencies in their response time, scheduling time and/or providing medical documentation in a timely manner.
