Network Access & Analyst Coordinator
Manages access agreements with The Health Plan's (THP) national provider network partners by coordinating provider network access agreements per employer opportunity, monitoring provider network performance standards, training internal staff per provider network requirements, and implementing provider network standards in accordance with Corporate, State, and Federal guidelines in order to meet/exceed The Health Plan's accessibility, quality and financial goals.
Creates monthly network adequacy reports by line of business, analyzes results and communicates findings to Provider Contracting team to assure regulatory compliance with network adequacy standards. Prepares network disruption reports and runs "what if?" analysis to model the impact of provider network changes on network adequacy.
Knowledge of provider contract language, payment methodology and commercial/government program requirements. General understanding of various provider networks, their operations, data configurations and workflows including internal and external operating partners.
- College degree or minimum of 5 years' experience in managed care organization/health industry;
- Experience using GeoAccess and Quest Analytics provider network adequacy tools;
- Previous provider service experience with exposure to provider contracting or provider network management;
- Experience in implementation of provider network access and stop loss provisions;
- Proficiency with Microsoft Word, Excel, Power Point and Outlook.
- Strong communication skills and the ability to communicate (oral and written) effectively;
- Organizational skills with the ability to handle multiple tasks and/or projects at one time;
- Customer service skills with the ability to interact professionally and effectively with providers, physicians and staff;
- Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time;
- Track record of producing work that is highly accurate, demonstrates attention to detail and reflects well on the organization;
- Problem resolution skills.