Provider Network Development Specialist

Apex Health Solutions

Houston, TX

Expired: over a month ago Applications are no longer accepted.

Full-Time

Job Description

Summary
Position is responsible for network development and adequacy activities including but not limited to: provider data analysis and integrity, maintenance of provider roster, regulatory reporting production, and supporting both product and geographic expansion efforts. This role helps to support several workflow processes within the network development team and will need to be comfortable working with other team members and departments. Typically reports to a Network Operations Leader.

Essential Functions

Responsible for provider research, analysis, & data maintenance to ensure viable and adequate provider network(s)
Supports the network development team with provider outreach and contracting processes
Obtains and maintains required documentation from providers that have been targeted for network adequacy
Consistently monitors network adequacy status and reporting in comparison with applicable requirements and business initiatives
Provides ongoing support to network management and other internal stakeholders as appropriate
Composes all correspondence and contract information concisely and accurately, in accordance with regulatory requirements
Maintains well-organized, accurate, and complete files for all provider data, contracts, outreach, correspondence, outcomes, and supports the accuracy of the network management contract database
Monitors each request to ensure all internal and external regulatory timelines are met
Collaborate with internal and external stakeholders to ensure prompt and appropriate action is taken regarding provider network development related activities
Supports network development activities and initiatives to support improvement in network performance
Assists in monitoring network composition including review of quality, efficiencies, and member satisfaction
Reviews network composition and analytics to ensure meeting regulatory requirements, provider accessibility, provider network standards, and network engagement in value-based care goals
Collaborates with internal teams to develop analytical reports and monitor network, maintain provider resources including the provider manual and provider directory, update of referral management tools, and ensure data integrity of the network.
Collaborates with teams and providers to promote growth initiatives expanding network and membership growth

CANDIDATE QUALIFICATIONS
Education

High school diploma required;
Bachelor’s Required or relative experience in healthcare field

Licenses/Certifications

None

Experience

Two years (2) years of experience working in a health care or regulatory environment preferably including experience working with provider clinics, regulatory agencies, data analysis, and project management

Responsibilities

Understanding of CMS and TDI Network Adequacy Standards and Regulations
Responsible for the outreach of potential network providers to meet the network adequacy regulations and expansion of the current network
Responsible to collaborate with internal and external stakeholders to meet regulatory reporting deadlines
Other duties assigned to assist with the success of the network operations team

Skills

Experience with Microsoft Office and Visio
Skilled in the use of Excel for data analysis
Preferred systems knowledge – HRP, Symplr (or similar contract database), Quest Analytics, etc.
Preferred provider relations or network operations experience
Effective and professional oral and written communication skills
Strong interpersonal skills to work with all levels across all functional areas to include internal and external business partners