The Network Management Specialist will assist in building and maintaining high-performance provider networks by identifying opportunities to contract with providers and improve the contractual performance. Works closely with other departments to enhance the contracted provider experience consistent with company's mission statement and values.
General Duties/Responsibilities:
(May include but are not limited to)
Recruits new providers.
Prepares supporting documentation, negotiates and implements contracts for physicians and ancillary providers for existing and developing markets.
Acts as technical resource on provider relations issues. Responsible for timely and professional interaction with internal and external customers.
Utilizes understanding of the business risk relationships to interact and influence key physician leaders.
Maintains internal awareness of network changes by issuing timely and accurate provider update communications about contractual risk disposition changes, provider terminations and additions, and panel closures.
Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and timeframes.
Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of terminations and/or provider changes.
Supports department efforts and Network Management by participating in interdepartmental meetings and selected committees.
Contributes to team effort by accomplishing related results as needed.
Minimum Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience:
Minimum 5+ years' experience in provider relations/contracting with an HMO or IPA, medical group or institutional provider required.
Education/Licensure:
Bachelor's Degree preferred.
Other:
Knowledgeable of reimbursement structures for physicians and ancillary providers.
Knowledgeable about Medicare guidelines
Strong analytic, quantitative, and problem-solving skills required.
Strong verbal and written communication skills required.
Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
Proficiency in MS Word and Excel required; Access database proficiency preferred.
Work Conditions:
Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
20% travel may be required at times.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
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.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
