Senior Network Representative

Martin's Point Health Care • Portland, ME

18h

About The Position

The Senior Network Representative is responsible for contracting, educating, and maintaining provider networks that deliver clinical, financial, and service value to Martin’s Point Health Plan members. The role manages provider contracting functions across existing and future markets and evaluates the composition and performance of the provider network. This includes monitoring primary care incentives and comprehensive visit performance, managing provider issues, and attending compliance and credentialing site visits to support network quality and HEDIS/NCQA requirements.

The position works closely with the Sales Team to recruit providers in support of membership growth targets and participates in member seminars, charity events, quarterly sales meetings, and other network-provider activities. It also handles complex contracting and renegotiations, leads contracting for new market expansions, supports provider education and training, and coordinates with operations and credentialing staff to maintain accurate contracts, payments, systems, and delegated agreements.

The role requires a bachelor’s degree or an equivalent combination of education and experience, at least five years of experience in provider relations and health care, including provider contracting involving physician, facility, and ancillary contracts, and a valid driver’s license. Travel, including potential overnight stays, is required at least 50% of the time. The posted full-time salary range is $75,584.55–$93,369.15. The position is not eligible for immigration sponsorship, and hires must verify U.S. citizenship and complete employment eligibility verification due to the organization’s Department of Defense contract.

Requirements

• Bachelor’s degree or equivalent combination of education and experience.
• At least five years of experience in provider relations and health care, including provider contracting involving physician, facility, and ancillary contracts.
• Valid driver’s license with no restrictions or suspension.
• Advanced knowledge of managed care contracting and reimbursement methodologies.
• Understanding of health plan functions and activities.
• Proficiency in Microsoft Word, Excel, and Access Office Products.
• Superior verbal and written communication skills.
• Strong analytical skills to coach employees and providers on benefit and payment policies.
• Strong negotiation skills.
• Ability to make presentations and represent the organization externally in public forums.
• Strong attention to detail and ability to organize and execute multiple activities simultaneously.
• Problem-solving skills.
• Ability to work collaboratively to meet goals and independently.
• Ability to travel at least 50% of the time, with potential overnight stays.
• Must verify U.S. citizenship and complete employment eligibility verification upon hire due to the organization’s Department of Defense contract.

Responsibilities

• Handle high-level contracting and renegotiations with large and strategic provider groups and PHOs in existing or future markets.
• Lead contracting efforts for opening new expansion markets.
• Conduct provider education in-services and monitor primary care incentive payments, comprehensive payments, and risk arrangements.
• Conduct seminars and trainings to ensure participating providers follow payment policies and comply with DOD and CMS requirements.
• Attend quarterly Health Plan Sales meetings, submit monthly recruitment reports, and present key recruitment activity.
• Manage all hospital capital requests.
• Coordinate with the Senior Network Operations Specialist and Senior Credentialing Specialist to ensure contracting payments, language, applications, and systems are updated accurately and on time.
• Serve as the network management liaison for providers and credentialing to ensure delegated agreements are executed.
• Train new staff and act as a role model and coach.
• Assist with high-level audits and special contract projects.
• Develop contract and reimbursement manuals to ensure consistency and accuracy.
• Communicate substantial changes in benefits or programs to providers.
• Handle escalated provider issue-management cases, payment issues, balance-billing cases, and issues involving providers out of compliance.
• Attend compliance and credentialing site visits to support network quality and HEDIS/NCQA requirements.
• Work with the Sales Team to recruit providers toward membership growth targets and attend member seminars, charity events, sales meetings, and other network-provider activities.
• Travel, including potential overnight stays, at least 50% of the time.

Benefits

• Comprehensive benefits package including medical, dental, and vision coverage.
• Retirement savings with employer contributions.
• Paid time off, including volunteer time off.
• Pie day and other employee benefits.
• Potential additional compensation through incentive or commission-based programs, where applicable and subject to plan terms.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior