Lead Network Operations Analyst
About The Position
The Lead Network Operations Analyst is a key member of the Helion Network Strategy and Reimbursement team, providing significant support for complex operational aspects of network design/development and value-based reimbursement programs. This role involves evaluating networks and contract structures against current and future state strategies, making recommendations based on the Helion post-acute network strategy, and serving as a subject matter expert on contract terms, including payment provisions. The incumbent will also develop recommendations for standardizing these provisions to best practice, value-based arrangements across multiple business lines (Commercial, Medicaid, Medicare Advantage) and manage the implementation and program management of value-based payment arrangements. Collaboration with the Helion Network Operations team and other enterprise stakeholders, including contract administration, provider contracting, legal, compliance, provider audit, and multiple health plan clients, is essential.
Requirements
- Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health related field, or 6 years of related and progressive experience in lieu of a Bachelor's degree.
- 5 years in Health Care Administration, Contract Management, Network Development, Finance or a related field.
- Operations Provider Reimbursement
- Microsoft Word, Excel and PowerPoint
- Outstanding Interpersonal Communication Skills
- Strong Oral & Written Communication Skills
- Teamwork and Collaboration
- Business Analysis
- Problem Solving Skills
- Adaptability
- Program Management, Execution and Implementation
Nice To Haves
- 7 years in Health Care Administration, Contract Management, Network Development, Finance or a related field.
- 5 years in Business Analysis, Economic Modeling or related.
Responsibilities
- Serve as a subject matter expert (SME) on post-acute provider contracts across all client markets and geographies.
- Understand payment and other contractual provisions and their alignment with the HCS network and reimbursement strategy and roadmap.
- Make recommendations for the evolution of these aspects aligned to the strategic roadmap.
- Survey the provider landscape across geographies, including direct research and geo access/capacity modeling, to identify network development needs.
- Take a lead role in communication and development activities, including economic and rate modeling as needed.
- Work with key administrative and contracting personnel to update contracts across multiple clients and base contracts, supporting the annual network design cycle and ensuring providers receive appropriate notifications.
- Provide direction, guidance, and training to less experienced teammates.
- Serve as a liaison to the HCS Network Performance team as an SME for complex operational inquiries.
- Interact with providers to share knowledge, answer questions, or obtain needed documents and insights.
- Serve as project manager, assigning complex work and monitoring accuracy and progress.
- Play a lead facilitator role in the implementation and operational evolution of Value-Based-Reimbursement programs.
- Oversee the maintenance of provider participant lists, provider contact information, and records for auditing purposes.
- Support program operations such as requests for payments to providers.
- Support provider change of ownership processing and update/track provider repositories (e.g., CPR, Salesforce, eDelivery).
- Perform other duties as assigned or requested.
Benefits
- Pay Range Minimum: $79,300.00
- Pay Range Maximum: $127,100.00
- Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.
- The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
