Homeoffice HCBS Provider Contracting - LTSS Remote Indiana en Professional Management Enterprises

Description

Title: LTSS Provider Contracting
Location: Remote within Indiana | Travel as needed
Schedule: Standard business hours Monday - Friday 8am-5pm

Pay: $90,000

Benefits: 80 hours PTO after 90 days, 10 paid holidays, Health, Dental, and vision experience, 401k, supplemental insurance available as well

Position Overview

As an HCBS Contracting Network Specialist, you will be responsible for initiating, negotiating, and executing contracts with Home and Community-Based Services (HCBS) providers. You will also support provider recruitment, onboarding, and ongoing network relations, ensuring our provider network is strong, compliant, and well-supported.

How You’ll Make an Impact

• Serve as a subject matter expert in HCBS provider contracting, including communicating contract terms, payment structures, and reimbursement rates.
   
• Negotiate and execute contracts for new and existing providers.
   
• Maintain and track contracts and documentation in internal systems.
   
• Assist in identifying and recruiting providers to meet network composition and service needs.
   
• Function as a technical resource to resolve complex provider issues.
   
• Participate in Joint Operation Committees (JOCs) with larger provider groups to discuss issues, updates, and changes.
   
• Provide guidance on contract education, administrative policies, reimbursement, and non-routine claim issues.
   
• Coordinate claims resolution through collaboration with providers, claims, pricing, and medical management teams.
   
• Track and analyze provider utilization patterns to support quality service delivery and network retention.
   
• Conduct and track provider training initiatives.
   
• Research issues that may impact future negotiations or network stability.
   

Requirements

Required Qualifications

• Bachelor’s degree.  
• Minimum of 5 years of customer service experience, including at least 2 years as a Network Management Representative, or equivalent combination of education and experience.  

Preferred Qualifications

• Experience in provider contracting, including contract preparation, financial analysis, and rate proposal development.  
• Provider contract negotiation and execution experience.  
• Experience with HCBS providers strongly preferred.  
• Experience managing credentialing processes.  
• Provider recruitment experience.  
• Experience with program implementations.