Provider Network Specialist

Maryland Care Management Inc•Linthicum, MD

About The Position

Assesses network access and generates reports, including Geo Access, for provider network analysis and planning. Identifies recruitment opportunities and assists in the analysis and development of cost-effective, contractual agreements with healthcare providers and institutions that can be administered efficiently and that follow state and federal regulatory requirements. Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

Requirements

The ability to review and comprehend contracts and services.
The ability to present information effectively in one-on-one and small group settings to providers and employees.
The ability to use advanced reason to define problems, collect data, establish fact, draw valid conclusions, and design, implement, and manage appropriate action plans.
Advanced and meticulous organization and coordination.
Must be able to successfully utilize geographic accessibility data, and Microsoft Office Suite and common computer and office hardware.
Experience with large provider organizations, ancillary and hospital providers, clinical terminology.
Working experience with Geo Access or equivalent system is required.

Nice To Haves

Bachelor’s degree in business, health, management systems or closely related field is preferred, although an equivalent combination of formal education and experience may substitute for a degree.

Responsibilities

Evaluates current contracts, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to identify cost savings, while maintaining quality.
Researches current and new contract operational procedures; coordinates with appropriate departments, to streamline processes wherever possible.
Coordinates implementation of new contracts with departments involved.
Coordinates internal review and determine/evaluate administrative feasibility throughout the continuum of the contracting process.
Initiates contract flow process; ensures appropriate signatures, and data entry to system.
Acts as team lead and trainer for Provider Data Coordinators.
Ensures appropriate legal / regulatory review of contracts prior to execution.
Monitors provider availability and accessibility to ensure provider network coverage.
Creates and reviews Geo Access reports and makes recommendations for future provider network build-out.
Assists with onsite contractual reviews; ensures 100% accuracy and timeliness of information/modification data entry in provider files of Geo Access system.
Assists with training of providers regarding MPC processes and benefits; conducts follow-up training to ensure policy compliance and education continuity; disseminates written correspondence as necessary to address issues, problems, and new information, as needed.