Network Specialist
Company Name:
Alignment Healthcase
The Network Management Specialist will assist in building and maintaining high-performance provider networks (including Medical Groups, IPAs Hospitals, Physicians, and Ancillary Providers) by identifying opportunities to grow membership, improve the contractual performance, and enhance the providers experience.
General Duties/
Responsibilities:
(May include but are not limited to)
Supports efforts to improve Group/IPA financial performance by tracking and evaluating performance measures such as risk pool performance and bed day utilization and cost trends, identification, analysis and resolution of problem areas, communicating improvement requirements to providers/management team, and influencing provider to make systemic and operational improvements.
Enhances the relationship with provider organizations by conducting timely, effective Joint Operations Meetings and provider orientations, with appropriate data sharing, by efficiently and effectively responding to requests for information, by monitoring and influencing physician growth opportunities and trends, and by successfully resolving issues related to capitation, claims, and other operational functions.
Utilizes understanding of the business risk relationships to interact and influence Physician Group Administrators and key physician leaders.
Maintains internal awareness of network changes by issuing timely and accurate provider update communications about contractual risk disposition changes, provider terminations and additions, and panel closures.
Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and time frames.
Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of PCP terminations with member reassignment, as well as group terminations in accordance with the Block Member Transfer P & P. Maintains understanding of physician affiliation patterns and trends, and the political/financial forces driving network movement.
Promotes enrollment growth by supporting Marketing & Sales Department event planning and execution.
Supports improvement in risk-adjusted revenue by overseeing encounter data submission volume and HCC capture, coordinating and providing information and/or training providers where deficiencies are identified.
Supports department efforts and Network Management Manager by participating in interdepartmental meetings and selected committees.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Contributes to team effort by accomplishing related results as needed.
Minimum Requirements:
1.Minimum
Experience:1.Minimum 5
years experience in provider relations/contracting with an HMO or IPA, medical group or institutional provider required.
2.Education/Licensure:1.Bachelors Degree preferred.
3.Other:1.Strong analytic, quantitative, and problem-solving skills required.
2.Strong verbal and written communication skills required.
3.Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
4.Proficiency in MS Word and Excel required; Access database proficiency preferred.
Conditions of Work
Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
60% or more travel by car routinely required for Field Specialists. 20% travel by car required for In House Specialists.
Travel by plane required as needed to support provider services needs in other geographies.
Maintain reliable means of transportation. If driving, must have a valid drivers license and automobile insurance.
Please apply at:
Requisition #:356Estimated Salary: $20 to $28 per hour based on qualifications.
Alignment Healthcase
The Network Management Specialist will assist in building and maintaining high-performance provider networks (including Medical Groups, IPAs Hospitals, Physicians, and Ancillary Providers) by identifying opportunities to grow membership, improve the contractual performance, and enhance the providers experience.
General Duties/
Responsibilities:
(May include but are not limited to)
Supports efforts to improve Group/IPA financial performance by tracking and evaluating performance measures such as risk pool performance and bed day utilization and cost trends, identification, analysis and resolution of problem areas, communicating improvement requirements to providers/management team, and influencing provider to make systemic and operational improvements.
Enhances the relationship with provider organizations by conducting timely, effective Joint Operations Meetings and provider orientations, with appropriate data sharing, by efficiently and effectively responding to requests for information, by monitoring and influencing physician growth opportunities and trends, and by successfully resolving issues related to capitation, claims, and other operational functions.
Utilizes understanding of the business risk relationships to interact and influence Physician Group Administrators and key physician leaders.
Maintains internal awareness of network changes by issuing timely and accurate provider update communications about contractual risk disposition changes, provider terminations and additions, and panel closures.
Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and time frames.
Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of PCP terminations with member reassignment, as well as group terminations in accordance with the Block Member Transfer P & P. Maintains understanding of physician affiliation patterns and trends, and the political/financial forces driving network movement.
Promotes enrollment growth by supporting Marketing & Sales Department event planning and execution.
Supports improvement in risk-adjusted revenue by overseeing encounter data submission volume and HCC capture, coordinating and providing information and/or training providers where deficiencies are identified.
Supports department efforts and Network Management Manager by participating in interdepartmental meetings and selected committees.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Contributes to team effort by accomplishing related results as needed.
Minimum Requirements:
1.Minimum
Experience:1.Minimum 5
years experience in provider relations/contracting with an HMO or IPA, medical group or institutional provider required.
2.Education/Licensure:1.Bachelors Degree preferred.
3.Other:1.Strong analytic, quantitative, and problem-solving skills required.
2.Strong verbal and written communication skills required.
3.Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
4.Proficiency in MS Word and Excel required; Access database proficiency preferred.
Conditions of Work
Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
60% or more travel by car routinely required for Field Specialists. 20% travel by car required for In House Specialists.
Travel by plane required as needed to support provider services needs in other geographies.
Maintain reliable means of transportation. If driving, must have a valid drivers license and automobile insurance.
Please apply at:
Requisition #:356Estimated Salary: $20 to $28 per hour based on qualifications.
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