Sr Network Management Consultant - Work From Home
About The Position
This role is responsible for managing a complex and high-volume caseload of Senate Bill 1264 (SB 1264) disputes involving out-of-network providers, with a defined book of business and elevated responsibility for case outcomes. The Senior Network Management Consultant leads negotiation strategy and resolution efforts for both informal and formal disputes, ensuring alignment with regulatory requirements, contractual standards, and statutory deadlines. This role requires advanced negotiation skills, strong analytical judgment, and the ability to independently manage complex, high-impact cases from intake through resolution. The Senior Consultant serves as a subject matter expert on reimbursement disputes and regulatory processes, providing guidance on case strategy, escalation paths, and resolution approaches. This position plays a critical role in driving timely, compliant, and financially sound outcomes while maintaining operational excellence in a fast- paced regulatory environment.
Requirements
- Bachelor Degree and 3 years provider contracting experience OR 7 years business experience including 3 years provider contracting experience.
- Knowledge of provider and facility contracting, products, and claims/processing systems.
- Negotiation skills.
- Relationship building skills.
- Knowledge of marketplace.
- Meet deadlines and work well under pressure.
- Verbal and written communication skills.
- Organizational and planning skills.
- PC proficiency to include Microsoft Office.
- Analytical skills.
- Ability and willingness to travel within assigned areas of responsibility, including overnight stays.
Nice To Haves
- Excel with experience in Vlook ups & Pivot Tables.
- Knowledgeable of the TX SB1264 Law.
- Effective time management skills.
Responsibilities
- Managing a complex and high-volume caseload of Senate Bill 1264 (SB 1264) disputes involving out-of-network providers.
- Leading negotiation strategy and resolution efforts for both informal and formal disputes.
- Ensuring alignment with regulatory requirements, contractual standards, and statutory deadlines.
- Independently managing complex, high-impact cases from intake through resolution.
- Serving as a subject matter expert on reimbursement disputes and regulatory processes.
- Providing guidance on case strategy, escalation paths, and resolution approaches.
- Driving timely, compliant, and financially sound outcomes.
- Maintaining operational excellence in a fast-paced regulatory environment.
Benefits
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- Paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
- Annual incentive bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Senior
