Network Relations Consultant

Network Relations Consultant

The Network Relations Consultant position is responsible for the performance of network PCPs. Performance metrics for this position include Stars, AWVs, PAHAF received and model of care compliance.

How will you make an impact & Requirements :

Network Relations 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 :

Consistent PCP visits focused on : PAHAF completion, STARS gaps closed, AWV HCC Re-capture rate, PCP referrals.

Issue Resolution :

Issue identification & resolution : Claims Referrals and authorizations G&A Patient access.

Provider Education :

Model of Care Portal usage / training Referrals and authorizations New PCP on-boarding.

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