Network Relations Specialist

Responsibilities

• Development of an adequate provider network within assigned geographic markets. Includes Negotiating and renegotiating contracts with physicians and provider groups and facilities
• Responsible for collecting roster updates and standardizing information received with Analytics and IT teams
• Tracking and coordinating notification of effective date with the credentialing CVO
• Maintenance and management of the network in accordance with regulatory time, distance and choice requirements
• Building and maintaining relationships with contracted providers, including responding to inquiries related to contract status, roster corrections and matters related to information accuracy
• Routinely running and monitoring of various reports to ensure all necessary compliance requirements are being met and maintained, and identifying targets to address emergent gaps
• Accurate maintenance of Salesforce or similar contract tracking and activity system
• Reporting to leadership the current status, risks, and potential opportunities in area of responsibility on a regular basis
• Working with analytics and actuarial team(s), compile and analyze provider and hospital fee schedules to benchmark against goals and assist with the medical economics reporting
• Performs other duties as required

Qualifications

• Experience negotiating commercial contracts with hospital systems, provider groups
• 5+ years negotiating provider contracts including physician / provider group contracts with multiple payment methodologies, e.g. percent of Medicare, RBRVS, ICD or similar code set, case rates, DRG, as well may include discussion of value based/risk parameters
• Analytic capabilities, including experience with SERFF reporting of network adequacy
• Experience with Salesforce or similar contact management system
• Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.
• Bonus: Experience in multi-state or national provider contracting

Telecommuting Requirements

• Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
• Ability to keep all company sensitive documents secure.
• Must live in the United States.
• Must live in a location that receives an existing high-speed internet connection/service.

Location and Benefits

• This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
• Company business hours are weekdays 9-5 CST.
• Full benefits package including health insurance, 401(k) matching, vision, dental, life, disability, and vacation.