Network Contracting Representative

Company Overview: Health Network One (HN1) partners with health plans and providers to modernize how specialty care is delivered and managed, reducing complexity, driving better performance, and improving lives. With over 30 years of experience, Health Network One advances care in several unique specialties: Total Eye, Sleep Well, Pure Derm and Thrive Therapy. By curating specialty networks and credentialing providers who meet rigorous access and quality standards, we bring together value-based models and clinical expertise to ensure providers thrive, payers succeed, and members receive the high-quality care they deserve. Position Summary: Responsible for developing, maintaining and supporting the day-to-day Specialty Provider Networks (SPN) contracting initiatives, which the respective individual manager for Health Network One, Eye Management, and/or Therapy Network (collaboratively referred to as “HN1”). Key Responsibilities: Coordinate the prospecting calls to potential providers for inclusion in the targeted SPN, including the continued follow up and documentation. Generate leads for SPN contracting via different methods, but not limited to: search engines, health plan directories, State Agency Provider lists, DOH license database and NPPES. Coordinate the entire contracting process for all potential providers, including prospecting, negotiation and credentialing. Collect all providers signed contracts, applications and necessary credentialing information, ensuring each State credentialing standard is maintained. Support the activities of Network Development for the corresponding SPNs assigned, including: Provider Communications, Provider Outreached, Provider Contracting, Provider Education and Provider Services, among others. Complete Provider Maintenance Forms (PMF), when needed, for Provider additions in the Network. Maintain a close working relationship with the TPA operations staff and work interdependently with each Department: Claims; Utilization Management; IT; Credentialing; and Provider File Maintenance. Advise Management of both strengths and weaknesses in the SPN and institute or recommend changes which better serve the organization and its assigned membership. Act as a liaison between HN1 and key and/or high volume Providers with all relevant matters concerning contractual and financial terms as stated in Providers’ contract with HN1. Provide and support network reporting requirements for SPN development and expansions. Maintain familiarity with the managed care industry, such as availability of outside sources of information, statutes affecting HN1 business, current industry trends, and general services/locations of major non-contracted health plans and providers. Participate and contribute in staff and committee meetings as requested by the Contracting Manager, Contracting Director, Sr. Director of Network Operations, VP of Network Operations, President and/or COO, including evening quarterly Executive Committee Meetings and Medical Advisory Committees (MAC). Support company philosophies, objectives, decisions and policies. Require adherence to department and organizational standards, policies and procedures including HIPAA. Ensure integrity of data entered into Company systems and/or databases. Require traveling 50% of the time to the different networks around the Nation. Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards. Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures. Ability to work and work the regular schedule and shift for the position. Compliance with all personnel policies and procedures. Perform additional duties and related essential duties as assigned. Qualifications: (5) or more years of contracting/development experience. Five (5) years of extensive working background in the managed care industry.