Provider Network Specialist

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

📋 Description

• Evaluate network access and produce provider network analysis and planning reports, including Geo Access reports.

• Identify opportunities for provider recruitment.

• Analyze and create cost-effective contractual agreements with healthcare providers and institutions.

• Review existing contracts and apply managed care reimbursement principles to uncover cost savings while ensuring quality.

• Investigate operational procedures related to contracts and collaborate with departments to enhance processes.

• Oversee the implementation of new contracts.

• Manage internal reviews and assess administrative feasibility throughout the contracting process.

• Initiate contract workflows, secure necessary signatures, and input data into systems.

• Serve as a team lead and trainer for Provider Data Coordinators.

• Ensure legal and regulatory scrutiny of contracts prior to execution.

• Monitor provider availability and accessibility to guarantee network coverage.

• Generate and assess Geo Access reports, suggesting future expansions of the provider network.

• Assist with on-site contractual evaluations.

• Guarantee the accuracy and punctuality of provider-file and Geo Access system data entry.

• Educate providers on MPC processes and benefits, provide follow-up training, and distribute written communications as required.

⛳️ Requirements

• Capability to review and understand contracts and services.

• Proficiency in effectively presenting information in one-on-one and small group environments.

• Advanced analytical abilities to define problems, gather data, establish facts, draw valid conclusions, and manage action plans.

• Strong organizational and coordination skills.

• Ability to utilize geographic accessibility data.

• Proficiency in Microsoft Office Suite and common computer and office devices.

• A Bachelor’s degree in business, health, management systems, or a related field is preferred.

• A combination of formal education and experience may be considered in lieu of a degree.

• Experience with large provider organizations, ancillary providers, and hospital providers.

• Familiarity with clinical terminology.

• Practical experience with Geo Access or a similar system is mandatory.

🏝️ Benefits

• Competitive salary.

• Medical insurance plans.

• Dental insurance options.

• Vision insurance coverage.

• 100% employer-funded Term Life Insurance.

• Short-Term Disability coverage.

• Long-Term Disability coverage.

• 401k Employer Matching up to 4%.

• 20 days of Paid Time Off (PTO).

• Tuition assistance programs.

• Plans for professional development.

• Flexible working arrangements.

• Social opportunities across the organization.