Develops and maintains provider relationships within designated state/territory that TriWest is responsible for direct contracting. Manages network development activity with network providers and recruits new providers to meet business needs. Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives.
Education & Experience
o Bachelor's degree in Business, Health Care Administration or equivalent experience
o Provider contracting and negotiation experience
• 5 years of experience in a Managed Care environment
o Experience in provider contracting for government programs and/or commercial lines of business
o Has established relationships and resides in the market for the which the position is located.
• Management experience in the healthcare industry
• Experience in utilizing a contract management system to manage contracting workflow
• Provides legendary service and support to maintain strong relationships with internal and external customers.
• Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
• Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to Sr. Manager for inclusion in overall network development plans.
• Regularly reviews and determines appropriate network access and development and makes reccomendations to support network build activities.
Provides regular updates to the Sr.Manager and/or VP regarding provider network development, management, and access for assigned areas.o Monitors and ensures resolution of routine and escalated provider issues
o Communicates information regarding market needs, competition, and industry trends to management team.
o Provides training and development to team members.
o Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
o Maintains client confidence and ensures confidential information is protected.
o Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
o Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
o Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
o Provides development and training to Network Providers on changes and updates to TriWest processes and policies.Identifies issues for future educational seminars that are identified through provider interactions.Collaborates with Provider Education to incorporate these ideas in upcoming provider education materials and updates.
o Assists provider community with any claims issues, including Electronic Media Claim filing problems, reimbursement issues, and billing questions. Answer general questions on credentialing process and technical aspects of the Program.
o Monitors and responds to network shortfalls within region.
o Demonstrate and maintain current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
o Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement
o Collaborate closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes
o Head or participate in projects and committees assigned by Sr. Contracting Manager or Vice President.
o Performs other duties as assigned.
o Regular and reliable attendance is required.