Senior Network Representative (remote) - Pittsburg or Cleveland territory

Position Summary

This position is remote, but must be located within Ohio or Pennsylvania. The Senior Network Representative is responsible for leading the contracting, negotiations, recruitment/expansion, and education functions within their assigned territories.

Job Description

• Handles high level contracting and renegotiations with large and strategic provider groups, and PHO’s, in all our existing or future markets to ensure complex contractual obligations are being met.
• Leads the contracting effort for opening new expansion markets and maintains the new education orientation and continues the relationship once contracted.
• Conducts high level provider education in-services and monitors primary care incentive payment, comprehensive payments, and risk arrangements to all existing participating providers.
• Develops PowerPoints including various types of provider education trainings to ensure providers are following our payment policies and are following DOD and CMS requirements.
• Develops PowerPoints and facilitates at all Provider Seminars for Recruitment seminars for new providers through market expansion.
• Attends Quarterly Health Plan Sales meetings, submits monthly recruitment reports and presents on key recruitment activity.
• Defines new market expansion areas through research and high-level reporting to compile strategic goals.
• Travels to multiple onsite visits to cover all our geographic footprint.
• Works closely with the Senior Network Operations Specialist and Senior Credentialing Specialist to ensure contracting payments, language, application, and systems are timely and accurately updated.
• Works as liaison for providers and credentialing to ensure delegated agreements are executed.
• Partners with Provider Relations Rep and Network Rep- Performs training, coaching, and mentoring for these two roles.
• Aids in high level audit and special contract projects meeting strict timelines.
• Develops our contract and reimbursement manuals to ensure consistency and accuracy.
• Communicates with providers regarding substantial changes in benefits or policy changes.
• Handles escalated provider issue management cases, payment issues, balance billing cases and providers that are out of compliance.

  Education/Experience

  • Bachelor’s degree or equivalent combination of education and experience
  • 5+ years of experience in department provider relations and health care including provider contracting involving physician, facility, and ancillary contracts experience

  Required License(s) And/or Certification(s)

  • Valid driver’s license (no restricted or suspended license)

  Skills/Knowledge/Competencies (Behaviors)

  • Significant proven advanced knowledge of managed care contracting and reimbursement methodologies
  • Understanding of health plan functions and activities
  • Proficiency in Microsoft Word, Excel, and Access Office Products
  • Superior communication skills, both verbal and written
  • Strong analytical skills to coach employees and providers on benefit and payment polices
  • Strong negotiations skills
  • Ability to make presentations and represent MPHC externally in public forums
  • Strong attention to detail with the ability to organize and execute multiple activities simultaneously
  • Problem-solving skills
  • Ability to work collaboratively to meet goals
  • Ability to work independently
  • Ability to travel with potential overnights at least 50% of the time

  Do you have a question about careers at Martin’s Point Health Care?

  Contact us at: jobinquiries@martinspoint.org