Network Management Consultant - Work From Home

HCSC•Richardson, TX

10h•Remote

About The Position

This is a detail-oriented Negotiation Specialist position to support the team in managing Senate Bill 1264 Texas cases. This role is responsible for handling a defined book of business and is responsible for handling a caseload of both informal and formal disputes involving out-of-network providers under Texas Senate Bill 1264 (SB 1264). The Network Management Consultant independently evaluates reimbursement disputes, applies applicable regulatory guidelines, and facilitates resolution through structured negotiation and case management. This role requires strong analytical and communication skills, the ability to manage multiple concurrent cases, and a solid understanding of healthcare reimbursement methodologies, provider contracting, and regulatory dispute processes. The Consultant ensures timely, accurate, and compliant resolution of assigned cases while maintaining effective communication with internal and external stakeholders. This position plays a key role in driving consistent case outcomes and operational efficiency within a high-volume regulatory environment, with the possibility to progress into a Sr. Network Management Consultant role over time.

Requirements

Bachelor Degree and at least one year experience developing and negotiating provider contracts OR 5 years managed care operations experience handling independent work with at least one year experience developing and negotiating provider contracts.
Meet deadlines and work well under pressure.
Verbal and written communication skills, organizational and planning skills.
PC proficiency to include Microsoft Office.
Analytical skills.
Ability and willingness to travel within assigned territory, including overnight stays.

Nice To Haves

Experience with Excel, specializing in Vlook ups & Pivot Tables.
Knowledgeable of the TX SB1264 Law.
Effective time management skills.

Responsibilities

Handling a defined book of business and a caseload of both informal and formal disputes involving out-of-network providers under Texas Senate Bill 1264 (SB 1264).
Independently evaluating reimbursement disputes.
Applying applicable regulatory guidelines.
Facilitating resolution through structured negotiation and case management.
Ensuring timely, accurate, and compliant resolution of assigned cases.
Maintaining effective communication with internal and external stakeholders.
Driving consistent case outcomes and operational efficiency within a high-volume regulatory environment.