Role Description
Designs, develops, contracts, maintains and enhances relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members. Manages and maintains relationships with healthcare providers within a network by:
• Negotiating contracts
• Evaluating provider performance
• Resolving issues or disputes
• Identifying network expansion opportunities
• Collaborating with internal and external stakeholders
Establishes relationships with network providers, fostering open communication and collaboration to ensure a strong network partnership.
• Analyzes network provider performance and quality indicators
• Conducts regular assessments and audits to ensure compliance with contractual obligations and service level agreements
• Addresses and resolves escalated issues and concerns raised by network providers
• Collaborates with network contracting teams to negotiate and establish contractual terms and conditions
• Develops tactical and operational plans to expand and enhance the network
• Monitors and analyzes network data, including provider demographics and network adequacy metrics
• Collaborates with cross-functional teams, such as finance, operations, and customer service
• Conducts regular meetings and performance reviews with network providers
• Stays updated on industry trends, regulatory changes, and market dynamics
Qualifications
• Must reside in Arizona, Northern Arizona preferred
• 5-7 years prior work experience in a healthcare environment
• Ability to travel up to 50% of time within Arizona
• Adept at problem solving and decision making skills
• Adept at growth mindset (agility and developing yourself and others) skills
• Adept at execution and delivery (planning, delivering, and supporting) skills
Requirements
• Certified Billing and Coding Specialist (CBCS) preferred
• Bachelor's degree preferred/specialized training/relevant professional qualification or equivalent professional experience
Benefits
• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility