Job description
Job Description
Job Title: Network Operations Representative
Department: Network Operations
Supervisor: AVP, Managed Care Network Operations
Licenses: None
Summary
Position is responsible for establishing, building, and maintaining relationships with the participating physicians of the Houston based Unity Health Partners Healthcare Collaborative and their office staff. The position assists in contract negotiations, contract management and optimizing a high-performing network of both PCP and Specialty physicians. The role develops and preserves strong relationships with physicians, office managers and supporting personnel with an eye toward optimizing value-based incentive relationships.
Location
Houston, TX
Essential Functions include the following. Other duties may be assigned.
Candidate Qualifications
Education
Experience
Skills
Technical Skills
Job Title: Network Operations Representative
Department: Network Operations
Supervisor: AVP, Managed Care Network Operations
Licenses: None
Summary
Position is responsible for establishing, building, and maintaining relationships with the participating physicians of the Houston based Unity Health Partners Healthcare Collaborative and their office staff. The position assists in contract negotiations, contract management and optimizing a high-performing network of both PCP and Specialty physicians. The role develops and preserves strong relationships with physicians, office managers and supporting personnel with an eye toward optimizing value-based incentive relationships.
Location
Houston, TX
Essential Functions include the following. Other duties may be assigned.
- Provide operational and managerial support to HCC physicians, including but not limited to:
- Provider Contracting (professional, ancillary and vendor);
- Shared Savings
- Quality Incentive Programs
- Partial and Full Risk-Based Initiatives
- Provider Information and Credentialing;
- Provider Relations, Account Management & Education;
- Data Exchange and Integrity;
- Reimbursement and Data Analysis; and,
- Communications and Relationship Management
- Provider Contracting (professional, ancillary and vendor);
- Create and deliver materials to educate physicians and their office personnel with regards to contracts, policies and procedures, quality and service line initiatives, and financial performance.
- Serve as the primary liaison for physicians and their practices participating with the HCC in value-based care initiatives.
- Establish and maintain a supportive, collegial role with HCC physicians and their practices.
- Proactively identify interventions that will facilitate success in practices.
- Take appropriate actions to increase revenue, leverage resources, manages and/or minimizes expenses, drive medical expense initiatives and ensure compliance with all regulatory requirements.
- Understand, develop, track, monitor and report on key program performance metrics, such as utilization, coding, and STARs/quality performance.
- Facilitate resolution related to practice concerns, grievances, claims and care delivery.
- Assist in the STARS and clinical metrics data collection, and design plans for enhanced provider engagement in quality initiatives.
- Prepare materials and participate in monthly operational meetings with senior leadership.
- Partner with other internal departments, including but not limited to Health Services, Medical Economics, Sales, and Quality/Coding in order to develop solutions for strategic business needs.
- Support network related activities associated with any expansion initiatives in new markets.
- Perform other duties as assigned.
Candidate Qualifications
Education
- Required: Bachelor's Degree
- Preferred: Master's Degree
Experience
- Required 3+ years of experience in managed care environment, health plan finance, provider network management or managed care consulting.
- At least one year related experience with physician engagement and/or value based reimbursement models.
- Demonstrated knowledge of contracting process, Medicare fee schedules, financial terms, and metrics.
Skills
- Knowledge of healthcare delivery
- Knowledge of community, state and federal laws and resources
- Ability to analyze and interpret financial data and quality information
- Ability to work in a fast paced environment with changing priorities
- Ability to work with others in a matrixed environment
- Ability to work within tight timeframes and meet strict deadlines
- Demonstrated leadership skills
- Demonstrated time management and priority setting skills
- Demonstrated analytical skills
- Demonstrated written communication skills
- Demonstrated problem solving skills
- Demonstrated negotiation skills
- Demonstrated interpersonal/verbal and written communication skills
- Demonstrated organizational skills
- Demonstrated presentation skills
- Demonstrated ability to converse with and deliver complex messages to physicians and physician personnel
Technical Skills
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft PowerPoint
- Required Intermediate Microsoft Excel
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