Advisor, Network Development

Northwell Health

12d

About The Position

Manages and negotiates the development and implementation of professional, ancillary and facility contracts for the Northwell Direct provider network. Addresses operational and contractual issues and ensures contract rates and contract terms are implemented and maintained in accordance with contractual obligations.

Requirements

Bachelor's Degree or Master's Degree, equivalent combination of education and related experience
All licensures and certifications needed for function and level, if any
Minimum Prior Technical Experience = 10+ years
Minimum Leadership/Management Experience = 2+ years

Nice To Haves

Experience as a primary point of contact for provider inquiries regarding claims, policies, benefits, and network participation preferred.
Familiarity with operational onboarding from contracting to the orientation process for newly contracted providers.
Knowledge of provider data management, credentialing, contract loading and provider directory processes.
Experience collaborating with both internal and external partners to investigate, troubleshoot, and resolve provider disputes, claim issues, and payment grievances.
Understanding of medical terminology, health insurance claims and coding (ICD-10, CPT, DRG), and payer systems.
Basic understanding of provider contracting.

Responsibilities

Devises new methods and procedures using strong analytic and inductive thinking
Works with senior executives to develop and drive system-wide functional strategies, as well as external strategies
Advises one or more areas, programs or functions and provides recommendations to senior executives on matters of significance
Negotiates and problem solves conflicts with operational and third party issues
Regularly makes decisions under minimal guidance that have significant impact on financial and business operations
Works both independently and collaboratively at the most advanced level across multiple areas
Partners with providers to collaborate on contracts
Manages physician recruitment and acts as a physician liaison
Involved with rate negotiations and analytics
Provides guidance to operational team members from basic to complex tasks and projects
As a subject matter expert, works at high levels in multiple knowledge and functional areas across and outside of the system
Majority of contact is within our own function or area; will collaborate with other professionals outside of own function and outside of the system
Serves as project/technical lead on small to medium sized projects
Skilled with broad, advanced provider and/or contractor experience