Lead Network Operations Analyst

Company :

Job Description : 

JOB SUMMARY

The job is a key member of the Helion Network Strategy and Reimbursement team, taking a significant support role for complex operational aspects of network design/development and value-based reimbursement programs.  This includes evaluating networks and contract structures relative to current and proposed future state through the lens of the overall Helion post-acute network strategy, and making recommendations based on an understanding of that strategy.  The incumbent will also support Helion as a subject matter expert on contract terms, including payment provisions, and develop recommendations for how to standardize these provisions and terms to best practice, value-based arrangements across multiple business lines, including Commercial, Medicaid, and Medicare Advantage.  This role will also be responsible for the implementation and program management of value-based payment arrangements.  The bulk of these activities will be accomplished through partnership with the Helion Network Operations team in addition to other stakeholders across the enterprise.  Will work across the matrix to partner with key functions, including contract administration, provider contracting, legal, compliance, provider audit, and other key implementation stakeholders, and support multiple health plan clients.  

ESSENTIAL RESPONSIBILITIES

• Source and act as subject matter expert (SME) on post-acute provider contracts across all client markets and geographies.  Understand payment and other contractual provisions and how those align to the HCS network and reimbursement strategy and roadmap.  Make recommendations on evolution of these aspects aligned to the strategic roadmap.

• Survey provider landscape across geographies, including direct research and geo access/capacity modeling, to understand where network development may be needed and take a lead role for communication and development activities, including economic and rate modeling as needed.

• Work with key administrative and contracting personnel to make updates to contracts as needed across multiple clients and base contracts, including to support the annual network design cycle, and ensure providers receive appropriate notifications.

• Provide direction, guidance, and training to teammates with less experience.  

• Serve as liaison to HCS Network Performance team as SME for complex operational inquires and interact with providers to share knowledge, answer questions or obtain needed documents and insights when requested.

• Service as project manager, assigning complex work and monitoring the accuracy and progress of assigned work.

• Work cross-functionally to play a lead facilitator role in implementation of Value-Based-Reimbursement programs and operational evolution of those programs

• Oversee the maintenance of provider participant lists in multiple programs, and provider contact information, as well as records for auditing purposes.  Support program operations such as requests for payments to providers.

• Work across the matrix to support provider change of ownership processing and make/track updates to provider repositories (i.e. CPR, Salesforce, eDelivery).

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health related field

Substitutions

• 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

• None

EXPERIENCE

Required

• 5 years in Health Care Administration, Contract Management, Network Development, Finance or a related field

Preferred

• 7 years in Health Care Administration, Contract Management, Network Development, Finance or a related field

To Include:

• 5 years in Business Analysis, Economic Modeling or related

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Operations

• Provider Reimbursement

• Microsoft Word, Excel and PowerPoint

• Outstanding Interpersonal Communication Skills

• Strong Oral & Written Communication Skills

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