Network Development Specialist
MultiPlan - Irving, TX
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JOB SUMMARY:This position 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 the Company's policies, practices and proceduresJOB ROLES AND RESPONSIBILITIES:1Negotiate 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.2Foster and maintain superior provider relationships.3Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals.4Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends.5Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement.6Work with Regional Sales and Accounts Management Peers to respond to and anticipate access requirements and network related performance guaranteesUse information derived from Requests for Proposals (RFP) to assess network adequacy and competitiveness in region.7Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources.8Ensure compliance with established policies and procedures and with regulatory requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources).9Collaborate, coordinate, and communicate across disciplines and departments.10Demonstrate Company's Core Competencies and values held within.11The position responsibilities outlined above are in no way to be construed as all encompassingOther duties, responsibilities, and qualifications may be required and/or assigned as necessary.JOB SCOPE:The incumbent works under general supervision in applying a fundamental knowledge of principles, practices, and procedures related to the negotiation and maintenance of provider network contractsThis job is considered to be the entry level job into the Provider Contractor job familyAn incumbent follows established procedures and confers with their supervisor to obtain approval and authorization to act outside the standardized proceduresMinimal latitude exists for unreviewed action or discretionMore complex issues are referred to their supervisor for resolutionThe work is varied and may be somewhat difficult in character and nature but usually involves limited responsibilitySome evaluation, originality, and/or ingenuity may be requiredAn incumbent may be called on to work with more experienced Provider Contractors on a project or team basisThe job may require overnight travel to meet with providers in assigned geographical or areas of responsibility and/or travel to company sponsored meetings and eventsThe incumbent will work to develop the skills necessary to strategize construct and negotiate complex financial rate structures and contract language, and can demonstrate successful negotiations that require this skill set.
Created: 2024-10-11