Network Development Specialist III

SKYGEN•United States,

1d•$30 - $45•Remote

About The Position

This role serves as a subject matter expert for resolving complex provider contracting issues and escalations. The specialist will provide education to providers about processes and procedures as they enter the network, as well as offer resolutions to common issues and questions. The position involves delivering training specific to the Network Development job function and managing the Network Development Knowledge base.

Requirements

Bachelor’s Degree in business or related field or equivalent years of experience.
Minimum of 5 - 7 years of experience related to contracting, network development, or network management.
Comfort with phone outreach is essential.
Intermediate knowledge of Microsoft Office products including Word, Excel, and Outlook.
Subject matter expert relative to geographic access and other reporting.
Excellent communication written and verbal communication skills.
Ability to communicate effectively with a variety of communication styles.
Strong analytical skills.
Ability to lead projects and people.
Inquisitiveness and ability to manage situations and information that lacks clear definition.

Nice To Haves

Experience in sales or negotiation is a plus.
Bachelor’s Degree.
5-7 years in a Network Development role.
1-3 years in training, development and quality assurance.
Knowledge of standard dental, medical and/or therapy terminology.
Knowledge of internal software.

Responsibilities

Serve as subject matter expert relative to geographic access reporting to ensure department is targeting appropriate areas of need.
Provide support to team for department reporting.
Develop and maintain training materials and job aids.
Deliver new hire and ongoing Network Development training within the department.
Act as a mentor to junior team members and provide feedback as necessary.
Represent the department on organizational projects and system enhancements.
Serve as single point of contact relative to general/non-market specific inquiries.
Perform market analysis on new markets including identifying key providers needed to service members.
Develop and maintain complete understanding of contract and network requirements.
Identify opportunities for cost savings and process improvements related to the contracting process.
Perform analysis on providers that may be outside targeted reimbursement schedule or performance standards and develop strategies for cost reductions and increasing quality.
Provide support to team as subject matter expert relative to navigating proprietary software applications.
Perform prospecting calls to new and existing providers to discuss the benefits of joining our networks and providing education about our practices and reimbursement levels.
Conduct negotiations with complex and major provider contracts as needed to support network adequacy.
Conduct negotiations with key providers including large groups, hospitals, and dental schools within networks.
Manage contract activities with national corporate provider chains.
Create and maintain standardized campaign materials.
Manage networks for key clients or markets.
Lead contracting efforts on new multi-recruiter network build campaigns.
Develop and maintain provider relationships by interacting directly with the provider and serving as the main point of contact for the provider throughout the contracting process.
Ensure provider compliance with contracting process.
Leverage relationships with existing providers to generate referrals to additional providers in the network.
Identify network access and deficiencies and develops recruitment and contracting strategies.
Perform outreach calls in order to resolve specific access to care issues for members.
Maintain understanding of the web portal in order to effectively explain its functionality to providers.