Network Development Specialist / 1690 Job in Lake Forest 92630, California Us
Network Development Specialist / 1690
Position Description:
The Network Development Specialist is responsible for identifying and evaluating opportunities, negotiating optimal reimbursement rates, and drafting contracts for an assigned provider network to ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations and MultiPlan policies, practices and procedures.
JOB RESPONSIBILITIES:
1. Negotiate provider contracts to support penetration and discount objectives relative to competitive market tends and client expectations through comprehensive, aggressive execution of region specific contracting goals derived from national and regional objectives related to penetration and discount objectives, and improved contractual terms.
2. Foster and maintain superior provider relationships.
3. Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals.
4. Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends.
5. Ensure compliance with established policies and procedures and with regulatory requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources).
6. Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement.
7. Work with Regional Sales and Accounts Management Peers to respond to and anticipate access requirements and network related performance guarantees. Use information derived from Requests for Proposals (RFP) to assess network adequacy and competitiveness in region.
8. Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources.
9. Demonstrate commitment to MultiPlan core values.
10. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
The Network Development Specialist works under general supervision in applying a fundamental knowledge of principles, practices, and procedures related to the negotiation and maintenance of provider network contracts. This job is considered to be the entry level job into the Provider Contractor job family. An incumbent follows established procedures and confers with their supervisor to obtain approval and authorization to act outside the standardized procedures. Minimal latitude exists for unreviewed action or discretion. More complex issues are referred to their supervisor for resolution. The work is varied and may be somewhat difficult in character and nature but usually involves limited responsibility. An incumbent is expected to effectively communicate the MultiPlan Value Proposition. Some evaluation, originality, and/or ingenuity may be required. An incumbent may be called on to work with more experienced Provider Contractors on a project or team basis. The job may require overnight travel to meet with providers in assigned geographical or areas of responsibility.
Qualifications:
" Minimum Bachelor s Degree in related or applicable field, or equivalent experience related to network development
" Minimum 1 year experience in provider contracting and network development, or equivalent provider/payer experience
" Knowledge and understanding of provider finance components including budget, charge structure, reimbursement formulas and healthcare finance
" Knowledge of provider organizations and operations applicable to assigned focus
" Possess communication, analytical, negotiation, organization, and prioritization skills
" Possess business acumen and ability to elicit trust and credibility with all levels of the organization
" Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries
" Ability to build relationships with internal and external customers
" Ability to use computer software, hardware, and peripherals applicable to role
" Up to 50% tvel within assigned region, primarily to meet with providers on a frequent basis and, at times, with little advance notice, as well as travel to attend MultiPlan sponsored meetings and appropriate professional conferences
As an Equal Opportunity Employer, MultiPlan will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.