Network consultant serp_jobs.h1.location_city

Network Relations Consultant

The Network Relations Consultant is responsible for assigned network PCP performance including PAHAF completion, AWV and Star rating of 4 or above.

How will you make an impact & Requirements :

Network Management Consultant will own individual performance engagement and on-the-ground relationship development for new and existing MDs.

• 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 provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.
• May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
• Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
• May participation in Joint Operation Committees (JOC) of larger provider groups.
• Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
• Conducts seminars to support the understanding of managed care policies and procedures.
• Identifies network access and deficiencies and develops recruitment and contracting strategies.
• Coordinates and conducts provider training including developing and distributing provider relations materials.
• Responsible for providing quality, accessible and comprehensive service to the company's provider community.
• 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 :

Quality and AWV :

Provider Education :

Issue Resolution :

Compensation : $67,896K - $90,000K annual salary & bonus eligible