Provider Network Development Specialist

Job overview

The Provider Network Development Specialist role is an onsite position in Miami, FL, supporting provider-network development across South Florida. Compensation is not specified. The role supports Doctors Healthcare Plans' provider network and its contracting and regulatory work. The specialist develops, maintains, and expands provider relationships and agreements, while analyzing network needs and supporting accurate provider data. This work helps maintain a compliant, effective network of physicians, medical groups, ancillary providers, hospitals, and vendors.

What you'll do

• Ensure contract language complies with state, CMS, AHCA, and other regulatory requirements
• use approved provider agreements
• obtain and verify credential information
• negotiate provider agreements and amendments
• analyze network needs and payment arrangements
• maintain provider contract data integrity
• research claims and utilization for re-contracting
• compare potential providers
• support departmental projects.

What we're looking for

Skills & competencies

provider network development specialist

provider contracting

healthcare network

physician agreements

credentialing

medicare advantage

regulatory compliance

miami fl

doctors healthcare plans

full-time

miami-dade travel

negotiation

Work arrangement

• Weekend coverage required

Why this role

Requires regular travel between locations in the Miami-Dade region. English/Spanish bilingual ability is preferred; a bachelor's degree in health services administration, business, or a related field, or equivalent training and experience, is required.

About the employer

DOCTORS HEALTHCARE PLANS, INC. is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.