Network Management Specialist-Remote California
About The Position
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Network Management Specialist will assist in building and maintaining high-performance provider networks by identifying opportunities to contract with providers and improve the contractual performance. Works closely with other departments to enhance the contracted provider experience consistent with company’s mission statement and values. (May include but are not limited to) Recruits new providers. Prepares supporting documentation, negotiates and implements contracts for physicians and ancillary providers for existing and developing markets. Acts as technical resource on provider relations issues. Responsible for timely and professional interaction with internal and external customers. Utilizes understanding of the business risk relationships to interact and influence key physician leaders. Maintains internal awareness of network changes by issuing timely and accurate provider update communications about contractual risk disposition changes, provider terminations and additions, and panel closures. Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and timeframes. Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of terminations and/or provider changes. Supports department efforts and Network Management by participating in interdepartmental meetings and selected committees. Contributes to team effort by accomplishing related results as needed.
Requirements
- Minimum 5+ years’ experience in provider relations/contracting with an HMO or IPA, medical group or institutional provider required.
- Knowledgeable of reimbursement structures for physicians and ancillary providers.
- Knowledgeable about Medicare guidelines
- Strong analytic, quantitative, and problem-solving skills required.
- Strong verbal and written communication skills required.
- Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
- Proficiency in MS Word and Excel required; Access database proficiency preferred.
Responsibilities
- Assists in building and maintaining high-performance provider networks
- Identifies opportunities to contract with providers and improve the contractual performance
- Works closely with other departments to enhance the contracted provider experience
- Recruits new providers
- Prepares supporting documentation, negotiates and implements contracts for physicians and ancillary providers for existing and developing markets
- Acts as technical resource on provider relations issues
- Responsible for timely and professional interaction with internal and external customers
- Utilizes understanding of the business risk relationships to interact and influence key physician leaders
- Maintains internal awareness of network changes by issuing timely and accurate provider update communications about contractual risk disposition changes, provider terminations and additions, and panel closures
- Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and timeframes
- Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of terminations and/or provider changes
- Supports department efforts and Network Management by participating in interdepartmental meetings and selected committees
- Contributes to team effort by accomplishing related results as needed
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
