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.
DEPARTMENT: Provider Relations/Network Management
REPORTS TO: Manager, Network Management
- 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.
- Provides service and education to network physicians/providers.
- Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and 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.
- Bachelor's degree preferred or equivalent directly related Network Development or Provider Relations experience
- 3 years experience in Provider Relations or Network Development required.
- 3 years experience with managed care required.
- Previous contracting experience required.
Special Skills (e.g. 2nd language):
- Excellent influencing and negotiating skills.
- Ability to explain complicated financial terms and utilization data to physicians and staff.
- Excellent written skills.
- Excellent public speaking skills.
- Intermediate or stronger skill level with MS Word, Excel and Outlook required.
- Beginner with MS PowerPoint helpful.