Senior Director Network Operations
Senior Director Network Operations
Posted on :
16-03-2025
Employer Active
1 Vacancy
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Job Description
Remote with occasional travel 5
10 years of experience with health plan or provider organizations
Responsibilities
- Manage the provider contracting process for a rapidly growing health plan including
- Assuring that negotiators are efficient in their use of the correct documents
- Assuring that contracts are meeting standards
- Assuring contracts flow smoothly through the processes and that Claims
Operations can load the contract into our claim system.
- Lead the implementation of process improvements including streamlining processes adding automation and implementing new tools and vendor solutions.
- Collaborate with network contracting colleagues as well as legal department compliance credentialing and claim operations to optimize and streamline the entire contracting process.
- Establish an endtoend provider contract review policy and procedure incorporating the negotiation of language and rates to the entry in the claim system
- Manage all policies and procedures impacting the network development and credentialing teams; including development of new processes
- Lead the market fee schedule governance committee and ensure compliance with federal and state regulations
- Own and update the provider resources as needed to comply with regulations or expansion; including but not limited to the Provider Manual
- Identify potential risks associated with contracting activities and propose mitigation strategies
- Assist with internal and external audits
- Partner with Compliance to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity
- Create and maintain a library of approved Model Contracts for hospitals physicians/group and ancillary providers
- Reduce/eliminate rework or mitigation of unfavorable contract terms over time
Position Requirements
- Bachelors degree or equivalent experience in related field including 10 years of work
experience beyond degree within provider contracting and/or health insurance - Superior problem solving decisionmaking negotiating skills contract language and
financial acumen - Experience with physician group and ancillary provider contracting language and
reimbursement - Experience with credentialing
- Experience improving provider data accuracy
- Demonstrated experience in seeking out building and nurturing strong internal and
external relationships - Team player with proven ability to develop strong working relationships within a fast
paced organization - Customer centric and interpersonal skills are required.
Required Experience:
Director
Employment Type
Full-Time
Key Skills
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