Senior Network Specialist, Southeast Region

Oscar Health•Atlanta, GA

10d•$69,120 - $90,720•Remote

About The Position

The Senior Network Specialist is responsible for negotiating and managing contracts with healthcare providers (hospital/health system and individual) to build and maintain a robust network in assigned market/region; while also ensuring access to quality care and optimizing costs by analyzing provider performance and negotiating reimbursement rates, often involving complex contract terms and compliance with regulatory guidelines. The Senior Specialist also plays a role in recruiting new providers to the network, assisting with resolution of provider issues, and supporting cost-saving initiatives.

Requirements

2+ years of experience in provider network operations, contracting or provider services
1+ years of experience in Health Insurance (Individual and/or Medicare Advantage) and/or Healthcare industry
1+ years of experience navigating and organizing large data sets such as claim files and provider rosters

Nice To Haves

Associate's degree or equivalent professional working experience.

Responsibilities

Support and direct involvement with negotiating contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards, strategy, and regulatory requirements.
Conducts comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization.
With support from your leader, utilizes data and analytics of provider financial issues and competitor strategies to inform negotiation and contracting decisions.
Supports implementation of contracting policies and workflows; monitors and ensures effective and efficient contracting processes are in place.
With input and support from their leader, monitor and analyze key metrics for network performance, cost, and provider satisfaction, and provide reports to leadership for assigned provider accounts.
Ensure timely and professional resolution of provider issues
Build and maintain positive relationships with healthcare providers to ensure network stability and quality.
Assist in tracking and analyzing key performance indicators (KPIs) to monitor provider satisfaction and operational efficiency.
Support provider onboarding, training, and resource distribution..
Collaborate with internal teams such as Claims, Credentialing, and Contracting to resolve routine provider issues.
Participate in process improvement initiatives to optimize workflows and enhance provider experience.
Compliance with all applicable laws and regulations
Other duties as assigned