[Hiring] Senior Network Representative @Martin’s Point Health Care

Role Description

This position is remote, but must be located within Ohio or Pennsylvania.

The Senior Network Representative is responsible for contracting, educating, and maintaining provider networks that deliver clinical, financial, and service value to Martin’s Point Health Plan members. Responsibilities include:

• Handling high level contracting and renegotiations with large and strategic provider groups, and PHOs, in all existing or future markets.
• Leading the contracting effort for opening new expansion markets.
• Conducting high level provider education in-services and monitoring primary care incentive payment, comprehensive payments, and risk arrangements.
• Conducting seminars and trainings with all participating providers to ensure compliance with payment policies and DOD and CMS requirements.
• Attending Quarterly Health Plan Sales meetings, submitting monthly recruitment reports, and presenting on key recruitment activity.
• Responsible for all hospital Capital Requests.
• Working closely with the Senior Network Operations Specialist and Senior Credentialing Specialist to ensure timely and accurate updates of contracting payments, language, application, and systems.
• Acting as a liaison for providers and credentialing to ensure delegated agreements are executed.
• Providing training to new staff members and acting as a role model/coach.
• Assisting with high level audit and special contract projects.
• Developing contract and reimbursement manuals to ensure consistency and accuracy.
• Communicating with providers regarding substantial changes in benefits or programs.
• Handling escalated provider issue management cases, payment issues, balance billing cases, and compliance issues.

Qualifications

• 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.

Requirements

• Valid driver’s license (no restricted or suspended license).
• 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 policies.
• Strong negotiation 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.

Company Description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.