Job Description Summary

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This position is responsible for the performance of assigned contracted PCPs and PODs.

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How will you make an impact & Requirements

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Network Relations Consult Senior

Own individual performance engagement and on-the-ground relationship development for new and existing MDs. Key accountabilities include issue resolution, provider education and quality and performance.

• Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.

• Serving as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.

• May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.

• Functions as a high level technical resource to resolve or facilitate complex provider issues.

• Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.

• Provide assistance regarding education, contract questions and non-routine claim issues.

• Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.

• Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.

• Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.

• Tracks and conduct provider refresher training.

• Researches issues that may impact future provider negotiations or jeopardize network retention.

Requirements:

• Requires a Bachelor's degree

• Minimum of 5 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.

• Travels to worksite and other locations as necessary.

Compensation:  $77,832K - $97,290K & bonus eligible

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