Bringing humanity to health insurance
Network Relations Specialist
Location
United States
Posted
1 day ago
Salary
0
Seniority
Senior
Job Description
Network Relations Specialist
Evry Health
• 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
Job Requirements
- 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
Benefits
- Full benefits package including health insurance
- 401(k) matching
- Vision
- Dental
- Life
- Disability
- Vacation
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