JOB DESCRIPTION

Title: Provider Relations Contracting and Network Specialist

Department: Provider Network

Reports to: Manager, Contracting & Engagement

Education: Bachelor’s Required; Masters Preferred

Job Type: Full Time

Job Summary

Initiates dialog with prospective providers/ancillary providers (including, but not limited to, hospitals, skilled nursing facilities, skilled home healthcare agencies, and ambulatory surgical centers) based on business needs. Coordinates the initial application process for all provider types. Service providers to facilitate provider understanding of Plan Policies and Contractual Requirements. Develop and maintain positive working relationships with participating providers. Conduct analysis of business need and maintains network in compliance with business need; collaborates with marketing/sales and family practice center staff.

Responsibilities

• Review, analyze, negotiate, implement, and maintain existing contracts with an understanding of professional rate schedules and contractual language
• Identify network development opportunities through financial analysis, client requests, and product development Define performance improvement opportunities
• Review initial applications for completeness, timeliness, and accuracy in accordance with established guidelines
• Conducts new and on-going provider orientations/trainings, site visits as required
• Facilitate interdepartmental collaboration to resolve complex provider issues related to contracting and contract configuration.
• Manages territory, inclusive of strategic network partnerships and the Plan's family health centers
• Provides general instruction and support on USFHP products, provider manual, provider directory, Plan policies and Plan procedures
• Research, resolve, and respond to provider/ancillary provider inquiries including, but not limited to,

participation requirements, credentialing requirements, credentialing status, contract terms, fee schedules, reimbursement, utilization, access/availability standards, member eligibility, consult report requirements, etc.

• Document and track inquiries received and resolution.
• Monitor contract performance through site visits, claims and data analysis.
• Monitor quality and regulatory compliance and participate in annual HEDIS activities.
• All other duties as assigned by management

Years of Experience

• min. of 2 year’s experience in a provider contracting role with existing marketing relationships; experience with value based contracting a plus
• 3- 5 year’s experience working with providers including medical groups, ancillary vendors, and allied health professionals.

Technical Skills/Competencies

• Familiar with various reimbursement models including DRG, fee for service, bundle payments, etc.
• Industry payment rules, billing, coding, etc. a plus
• Proficiency in Microsoft Office (2010) Word, Excel, PowerPoint, and Access.
• Must be organized and detail oriented.
• Ability to meet stringent deadlines and adjust priorities with business needs.
• Excellent communication & analytical skills.

Education/Certification/License

• BA/BA required
• Masters in MPH Preferred

Additional Requirements:

• Access to personal vehicle
• Valid driver’s license
• Able to lift 20 pounds

SALARY RANGE: $70,000.00 to $75,000.00

SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN, DISABILITY OR VETERAN STATUS.

Job Type: Full-time

Pay: $75,000.00 - $89,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No weekends

Ability to commute/relocate:

• Manhattan, NY 10001: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor's (Required)

Experience:

• Provider Contracting: 2 years (Required)
• Provider Network Relations: 3 years (Required)

Willingness to travel:

• 25% (Required)

Work Location: In person

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