Provider Network Specialist jobs in Boca Raton, FL

About Us

MTI America is a health solutions company located in sunny Fort Lauderdale. As a leader in the Worker's compensation industry, our team of dedicated professionals seamlessly coordinates and delivers our ancillary product and service offerings. Passion for people is at the core of everything we do, and we understand the impact of empathy in healthcare. As a company built on lasting relationships, we utilize our network of providers to consistently deliver compelling customer-centric solutions from transport to language and medical services. Nationwide!

The MTI family has a strong passion for efficiency, customer care, and our people. We love what we do, we strive to be the best, and we are thrilled to serve our customers. We strongly believe that our culturally diverse teams of overly ambitious people are what makes our company a great place to work. We value our employees as much as we do our customers and offer a supportive environment complete with competitive compensation, benefits, and growth opportunities.

At MTI America, you will have a significant impact on the quality of care our patients receive. Your service will directly impact injured workers and their quality of life.

Summary

The Provider Network Developer initiates and closes on sales for the network expansion in defined territories and works as the liaison between Providers and organization. Identifies, selects, drafts, negotiates and sells final contracts. Creates processes and procedures to ensure overall quality of provider services. Facilitates development of relationships with providers, maintains relationships for long-term contracts, and mediates performance and scorecard disputes.

Job Responsibilities

• Creates short and long-term contracting sales strategy for the development and improvement of MTI America’s provider network.
• Negotiates all new and existing contracts within assigned territory.
• Ensures contractual agreements are met.
• Develops alternatives, strategies and plans of action to facilitate the negotiation process.
• Works independently and as part of a team on contract negotiations, re-negotiations, contract preparation, provider relations and recruitment.
• Reduces cost of goods sold through contract negotiations and re-negotiations of existing vendor contracts.
• Ensures quality components of service delivery and patient/carrier satisfaction with services provided.
• Establishes relationships with providers and prepares hand-off to account management team.
• Participates in process for continuous credentialing and quality monitoring of assigned accounts.
• Monitors state fee schedules to ensure vendor compliance.
• Works with team to identify margin opportunities by performing analysis out of network utilization and using data to identify network development opportunities.
• Performs ad-hoc negotiations with out of network vendors and strategically recruits new vendors based on feedback from Operations and Sales.
• Works closely with Internal Audit and Compliance (IAC) department to ensure vendor compliance with contracts as well as MTI America’s billing and other protocols.
• Identifies potential vendors for recruitment into the MTI America’s Management network
• Identifies white space and targets vendors in those areas for inclusion in the MTI America’s Management network.
• Manages contract process including distributing and receiving contracts.
• Acquires credentialing applications at initial contracting.
• Acquires liability and licensure on each provider at initial contracting.
• Other duties as assigned.

Skills and Expertise

• Good understanding focused on Transportation and language service industry and ancillary products and services.
• 3 years’ experience in network development in healthcare required; workers’ compensation preferred.
• Knowledgeable of contract negotiation principles.
• Excellent verbal and written communication skills to technical and non-technical audiences of various levels in the organization (e.g. executive, management, individual contributors).
• Excellent problem solving, team and time management skills managing multiple deadlines for self and others.
• Proficiency to operate independently on work that is often confidential in nature.
• Proficient in Microsoft Office Suite required.

Education Requirements

• High School Diploma or equivalent required. College degree preferred.

Travel Requirements

• N/A

Physical Demands/Work environment

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Individuals may need to sit or stand as needed. May require walking primarily on a level surface for periodic periods throughout the day. Reaching above shoulder heights, below the waist or lifting as required to file documents or store materials throughout the workday. Proper lifting techniques required. On occasion, may include lifting of up to 5 pounds for files and computer printouts.
• For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands, and fingers speak, and hear.
• Hearing, vision, and talking. Specific vision abilities required by this job include ability see things from a close distance and ability to adjust focus.
• Utilizes fluorescent lighting; noise level is moderate. For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office.