Network Relations Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Development of a robust provider network within designated geographic markets, which entails negotiating and renegotiating contracts with physicians, provider groups, and facilities.

• Responsible for gathering roster updates and standardizing the information received in collaboration with the Analytics and IT teams.

• Tracking and coordinating the notification of effective dates with the credentialing CVO.

• Maintenance and management of the network in compliance with regulatory time, distance, and choice requirements.

• Building and nurturing relationships with contracted providers, including addressing inquiries related to contract status, roster adjustments, and issues concerning information accuracy.

• Regularly running and monitoring various reports to ensure compliance requirements are fulfilled and maintained, while also identifying targets to tackle emerging gaps.

• Accurate upkeep of Salesforce or a similar contract tracking and activity management system.

• Reporting to leadership on the current status, risks, and potential opportunities related to the area of responsibility on a regular basis.

• Collaborating with analytics and actuarial teams to compile and analyze provider and hospital fee schedules to benchmark against goals and assist with medical economics reporting.

• Performs additional duties as required.

⛳️ Requirements

• Experience in negotiating commercial contracts with hospital systems and provider groups.

• Over 5 years of experience negotiating provider contracts, including those with physician/provider groups across various payment methodologies, such as percent of Medicare, RBRVS, ICD or similar code sets, case rates, DRG, and potentially involving discussions on value-based/risk parameters.

• Strong analytical skills, including familiarity with SERFF reporting for network adequacy.

• Proficiency in Salesforce or a comparable contact management system.

• Exceptional communication skills, both verbal and written, with a talent for developing and sustaining effective working relationships.

• **Bonus:** Experience in multi-state or national provider contracting.

🏝️ Benefits

• Comprehensive benefits package, which includes health insurance.

• 401(k) matching.

• Vision coverage.

• Dental coverage.

• Life insurance.

• Disability coverage.

• Paid vacation.