Provider Contracting & Negotiating Specialist

  • Location: Tampa, Florida
  • Type: Direct Hire
  • Job #10253

Provider Contracting & Negotiating Specialist
(Position can be on-site or hybrid remote)

Job Summary:

The Provider Contracting & Negotiating Specialist I is responsible for working on behalf of the client to negotiate their out of network claims when applicable. This person will work directly with out of network providers to work out a single case agreement/fee or direct contract for submitted medical claims.

Responsibilities:

  • Initiate contact with provider offices for out of network services working from a queue.
  • Negotiate fees and rates with out of network providers.
  • Perform data entry and documentation of repricing of medical claims.
  • Correspond with providers through phone, email, fax and record contact and progress.
  • Oversee process to ensure claim is adjudicated.
  • Work in team mailbox to provide responses and support.
  • Work directly with clients and other departments on negotiation requests.

Qualifications:

  • HS Diploma or equivalent.
  • 1 year of provider contracting, data or network administration experience preferably in a healthcare third party administrator setting or 2 years of claims processing or customer service experience is a medical/healthcare setting including knowledge of medical terminology.
  • Prior work in production environment.
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