Network Management Representative Senior

» Network Management Representative Senior
Healthcare
in Brentwood
, TN
Reference: 19-03601

Description:

  • Manages physician contracting, network development and provider relations functions for developing, executing and maintaining a provider network strategy
  • Works in concert with medical management and sales developing actions to meet market growth and medical cost targets
  • Provides service and education to network physicians/providers

Key Duties and Responsibilities:

  • Services, contracts and negotiates with primary care and specialty physicians and ancillary providers for all product lines
  • Identifies network gaps and complete contracts
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area
  • Provides service and education to network physicians/providers
  • Conducts site visits to service providers
  • Resolve issues
  • Educate staff/providers on policies
  • Collect credentialing information
  • Review HEDIS information
  • Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve/maintain regions
  • Manages incoming provider inquiries: identifies potential claims trends and follow-up with provider and internal departments to ensure that identified problems have been resolved
  • Strategizes for membership growth and retention
  • Performs other duties as assigned

Education:

  • A Bachelor’s Degree in a related field or equivalent work experience in Network Development or Provider Relations

Work Experience:

  • 3+ years of experience in Provider Relations or Network Development
  • 3+ years of experience in Managed Care
  • Previous contracting experience

Skills:

  • Demonstrated written communication skills
  • Demonstrated negotiation skills
  • Ability to explain complicated financial terms and utilization data to physicians and staff
  • Demonstrated interpersonal/verbal communication skills
  • Ability to multi-task
  • Demonstrated customer service skills
  • Ability to represent the company with external constituents
  • Knowledge of healthcare delivery
  • Knowledge of community, state and federal laws and resources

Technology:

  • Microsoft Excel
  • Microsoft Outlook
  • Microsoft Word

Level of Supervision Received:

  • Uses policies and general objectives with little functional guidance; rarely refers specific cases to manager unless clarification or interpretation of organization policies is involved