Network Development Specialist - Health Insurance

MRA Member Career Opportunities - Madison, WI (30+ days ago)3.0


The Opportunity
The Network Development Specialist plays an important role in building, maintaining and improving The Alliance's network. This position has responsibility for coordinating some of the processes related to contract maintenance, contract analysis, contract renewal and renegotiation. Working under general supervision and in coordination with other contract staff, this position serves as the primary source of contact for coding/billing and rate questions from contracted providers and may assist with coordination of gathering financial analytical information. This position also develops relationships with participating providers in provider specialty areas as designated, as well as ongoing contact with existing providers.The most critical responsibilities include:

Provider Contracting and Relationship Building with Ancillary Providers. Manages existing relationships and strategically recruits and contracts with prospective providers to assure the network meets the needs of current and future members in the areas of access and value. This position meets with providers to maintain and develop long-term relationships. Has an ongoing responsibility for assuring that the negotiated reimbursement rates are competitive. This position works under supervision and guidance of the Director regarding language and reimbursement modifications and is responsible for managing provider relationships and contractual arrangements that require minimal negotiation and language modifications.
Provider Inquiries. Serves as a point of contact for providers and staff who have questions about claims repricing, billing, coding or contract interpretation as designated. This may involve the investigation of claims-related issues, review of the contract and review of processing system data toward an appropriate resolution.
Coordination of Financial Information. Prepares and delivers fee modeling information as requested by providers. Assists the Analyst and other department staff in preparation of financial modeling as requested. Is responsible for assisting the Analyst with the process of provider rate increases. Additionally this position is responsible for coordination and maintenance of the QualityPath Claims Report function, which includes active communication with QualityPath participating providers, auditing of claims reports and distribution of claims reports to providers. May be responsible for maintaining other financial information and/or indexes as requested.
Complete other projects and duties to annual goals and objectives are met.

The Requirements
The ability to build long-term relationships with provider and with internal staff
Strong communication skills (both oral and written) with the ability to use this skills to build relationships, problem solve and negotiate.
Outstanding provider/customer service skills
An understanding of financial data and the ability to assist in the analysis of data.
Bachelor degree in a related field or equivalent experience in provider relations, network development, or contracting
At least two years experience working in healthcare or insurance in a provider relations contracting role or 2 years managed care experience
Strong computer skills, able to accurately maintain data and run reports in various systems.

The Organization
Celebrating 25+ years as a not-for-profit, employer-owned cooperative, The Alliance exists to help our members manage their health care costs, improve quality and engage individuals in their health. We serve more than 240 employers in Wisconsin, Illinois and Iowa and contract with more than 18,000 health care providers and specialists across that region. We provide information and resources to help members make health care purchases based on value and create healthier workforces.
In this role you ll be backed by a strong sales, member services, marketing, network development, customer service, technology and administrative teams. You ll be part of an organization with high levels of employee engagement. The Alliance is mission-driven, member-centered, respectful, and supportive of team members.
To learn more about The Alliance visit http://www.the-alliance.org/
To see how The Alliance's staff describes the organization view https://www.youtube.com/watch?v=bHSXbhPCo_c
The Alliance is unable to provide sponsorship for a H1-B work visa at this time.
Equal Opportunity Employer.
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You are hired directly by the company – MRA does not make hiring decisions.
MRA is a not-for-profit employers association serving over 3,000 companies throughout the upper Midwest. We partner with these companies working directly with their HR department and leadership to hire their talent. We are a direct line to the company, not an agency recruiter.