Position Summary
This position is remote, but must be located within Ohio or Pennsylvania.

The Senior Network Representative is responsible for leading the contracting, negotiations, recruitment/expansion, and education functions within their assigned territories. The Senior Network Representative works closely with their leaders and senior leadership to negotiate high-level language and financial contracting terms to secure large contracts. The Senior Representative completes all high-level provider education, including but not limited to new provider orientations, comprehensive, site, and routine trainings. They review and resolve high-level provider escalated cases to ensure all parties are compliant. This includes, but is not limited to, delivering clinical, financial, and service value to Martin's Point Health Plan Members. They must continually access the composition and performance of the provider network, including primary care incentive monitoring and CMS Star Ratings. The Senior Network Representative will attend compliance and credentialing site visits to assure we are providing a quality network and meeting HEDIS/NCQA requirements. The Senior Network Representative works closely with the Sales Team to actively recruit new providers to meet or exceed membership growth targets.
Job Description

Key Outcomes:

• Handles high level contracting and renegotiations with large and strategic provider groups, and PHO's, in all our existing or future markets to ensure complex contractual obligations are being met.
• Leads the contracting effort for opening new expansion markets and maintains the new education orientation and continues the relationship once contracted.
• Conducts high level provider education in-services and monitors primary care incentive payment, comprehensive payments, and risk arrangements to all existing participating providers.
• Develops PowerPoints including various types of provider education trainings to ensure providers are following our payment policies and are following DOD and CMS requirements.
• Develops PowerPoints and facilitates at all Provider Seminars for Recruitment seminars for new providers through market expansion. to
• Attends Quarterly Health Plan Sales meetings, submits monthly recruitment reports and presents on key recruitment activity.
• Defines new market expansion areas through research and high-level reporting to compile strategic goals.
• Travels to multiple onsite visits to cover all our geographic footprint.
  • Works closely with the Senior Network Operations Specialist and Senior Credentialing Specialist to ensure contracting payments, language, application, and systems are timely and accurately updated.
• Works as liaison for providers and credentialing to ensure delegated agreements are executed
• Partners with Provider Relations Rep and Network Rep- Performs training, coaching, and mentoring for these two roles.
• Assists with high level audit and special contract projects meeting strict timelines.
• Develops our contract and reimbursement manuals to ensure consistency and accuracy.
• Communicates with providers regarding substantial changes in benefits or policy changes.
• Handles escalated provider issue management cases, payment issues, balance billing cases and providers that are out of compliance.

Education/Experience:

• Bachelor's degree or equivalent combination of education and experience
• 5+ years of experience in department provider relations and health care including provider contracting involving physician, facility, and ancillary contracts experience

Required License(s) and/or Certification(s):

• Valid driver's license (no restricted or suspended license)

Skills/Knowledge/Competencies (Behaviors):

• Significant proven advanced knowledge of managed care contracting and reimbursement methodologies
• Understanding of health plan functions and activities
• Proficiency in Microsoft Word, Excel, and Access Office Products
• Superior communication skills, both verbal and written
• Strong analytical skills to coach employees and providers on benefit and payment polices
• Strong negotiations skills
• Ability to make presentations and represent MPHC externally in public forums
• Strong attention to detail with the ability to organize and execute multiple activities simultaneously
• Problem-solving skills
• Ability to work collaboratively to meet goals
• Ability to work independently
• Ability to travel with potential overnights at least 50% of the time

Pay Range:$75,584.55 - $93,369.15The pay range above reflects the anticipated base pay range based on a full-time position. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-related considerations. Employees may also be eligible for additional compensation, including incentive or commission-based programs, where applicable and subject to the terms of the relevant plan.In addition to base compensation, we offer a comprehensive benefits package including medical, dental, vision, retirement savings with employer contributions, paid time off (including volunteer time off!), pie day, and other employee benefits.
This position is not eligible for immigration sponsorship.