Location:Lee Health Corporate Center -4211 Metro ParkwayFort Myers FL 33916
Department: Business Development and Contracting
Work Type: Full Time
Shift: Shift 1/8:00:00 AM to 4:30:00 PM
Minimum to Midpoint Pay Rate:$30.32 - $39.42 / hour
This position requires a strong background in managed care payer contracts including negotiation and implementation of payer contracts, provider participation requirements for payer contracts, credentialing requirements, and provider network evaluation and assessment. Ability to understand the market impact of physician participation in payer contracts and knowledge of health insurance plan payment structures is essential. Must closely monitor market trends to identify value and performance of LMHS contracts and to identify opportunities to increase net revenue. Oversees credentialing of LMHS physicians and Lee Physician Hospital Organization (PHO) physicians to ensure status as participating providers in appropriate contracts and to ensure payments by health insurers are made at in-network benefit levels. Requires collaboration with multiple LMHS departments to manage complex and confidential information relating to credentialing. Responsibilities also include devising creative solutions to avoid payer/provider disputes and customer/provider disputes regarding health insurance benefits, payments, and physician participation. Requires meeting and providing orientation and education of managed care payer contracts to new physicians and practice administrators.
US:FL:Fort Myers
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