Network Contracting Representative

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.