Provider Network Development Analyst

Avera•Sioux Falls, SD

3d•Onsite

About The Position

The Provider Network Development Analyst is responsible for maintaining a current and comprehensive knowledge of geographic market differences which may influence how providers are contracted. The position serves as the primary source of network recruitment planning to drive understanding of the Avera Health Plans Network capabilities and benefits with the objective to secure participation and signed agreements with providers. The Provider Network Development Analyst will assist in the development of network expansion activities and contracting target lists. Comprehension of provider data, service areas and adequacy requirements, regulatory compliance with a deep understanding on the impact to sales activities, network gaps, along with exceptional communication are imperative for success. Acts as subject matter expert (SME), serves as a resource and mentor for other staff. Maintaining network KPI reports and performance dashboards. The Provider Network Development Analyst will use of analytics, competitor benchmarking, and network adequacy criteria to continually identify network expansion and implement plans to achieve business goals.

Requirements

The individual must be able to work the hours specified.
To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
Bachelor's
Minimum of five years experience in the health care industry

Nice To Haves

Minimum of three years of applicable experience with health insurance with focus on provider relations, contracting and credentialing.

Responsibilities

In partnership with your leader, development and implement, network expansion and maintenance strategies, and performance improvement strategies to ensure Avera Health Plans meets its financial performance targets.
Support analysis of supplier contracts in the assigned geographic area and maintain comprehensive understanding of a variety of provider networks (including narrow networks, self-funded networks, employer specific networks and comprehensive or PPO networks).
Assist with the development, implementation of broad based, tiered and narrow network products and value-based contract arrangements and plays a critical role in increasing brand awareness with providers by identifying, researching, vetting and developing an assessment of the provider and business landscape.
Produce annual network adequacy reports, templates and Health Service Delivery (HSD) tables to support successful product filings and development.
Lend support and network expertise to Business Development, Product and Sales teams in ad-hoc network analysis reporting including access and disruption reports for employer groups and RFP work.
Deliver dashboard reporting to demonstrate network adequacy, expansion and performance reporting to leadership that communicates to local market teams applicable updates regarding contracting efforts and results.
Track network adequacy across all service areas and Assist the Vice President of Network Development, Provider Relations and Contracting in partnering with the Sales, Account Management, Population Health and Product teams to identify supplemental network providers and ideas for network development/contracting efforts to produce networks that enhance sales activities and promote growth of Avera Health Plans.
Promote activities to achieve the overall strategy and objectives of the Network Services department, promoting Avera Health Plans integration conversations with existing and potential provider groups.
Responsible for accurate provider database management and regular updates to the provider data source of truth that supports network adequacy, disruption and access reporting.
Identify and research resources for developing specialist, primary care and behavioral health leads for new business areas and gaps in a comprehensive provider network and limited networks as designed by product offerings.
Conduct initial outreach and telephone communication which identify provider interest and qualifies them for contracting activities.
Analyze complex variables and recommend most appropriate contracting process.
Execute on special projects as assigned.