What are the responsibilities and job description for the MANAGER OF NETWORK DEVELOPMENT position at Patient Care America?
JOB SUMMARY:
The Manager of Network Development is responsible for overseeing all activities of the provider contracting, network development and provider relations and aid in formulating and administering organizational policies and procedures. This position will prepare, analyze, negotiate, and maintain contracts for the provider network for Patient Care America.
QUALIFICATIONS:
- Bachelor's degree in business administration, Health Care Administration, related field, or equivalent experience.
- 7 years of combined Managed Care or PBM contracting, network development or provider relations experience. Previous experience in Medicaid/Medicare contracting and negotiating and ancillary service agreements OR 10 years of provider negotiations and provider relations experience in lieu of bachelor’s degree.
- Deep understanding and working knowledge of managed care industry, market trends, payor types, various reimbursement structures and associated dynamics; established relationships with major insurers preferred.
- Experience in building sustainable partnerships between payors and providers.
- Exceptional oral, written, organizational and time management skills.
- Strong interpersonal skills to communicate with various personalities and situations.
- An outgoing, engaging, and energetic individual willing to interface with internal and external clients.
- Ability to function independently with a high degree of negotiation and contracting proficiency.
- Goal oriented with a proven record of accomplishment.
- Proficient in Microsoft Office Suites.
- Knowledge of IDPN and IPN a plus.
- Solution driven team player.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Prepare payor proposals, manage the negotiation process, and negotiate language and financial reimbursement terms with payors for both payor contracts and single case agreements.
- Monitor contract performance to identify reimbursement issues and ensure payors comply with all contract provisions, via tracking of performance through various means, including an audit of current performance via claims review, reports, etc.
- In collaboration with leadership, identify appropriate contracting and re-contracting opportunities and initiates discussions with key constituents.
- Ensure contractual terms, including payor-specific requirements, reimbursement logic, and limitations are understood.
- Serve as the expert on all terms of the payor contract for both internal and external parties.
- Maintain PCA Revenue Cycle Electronic interfaces (e.g., Billing, EFT & contract fee schedules), including an up-to-date inventory on applications/web portal name, administrator, credentials, and any other details required to perform changes of services or account.
- Manage and Maintain Contracting Database, ensuring accuracy of information, timeliness of updates and user-friendly access.
- Prepare and present reports on managed care performance and contract outcomes to senior management.
- Contact insurance companies to educate and promote PCA’s products and services.
- Manage and maintain all credentialing and enrollment efforts as needed.
- Maintain up to date of changing healthcare landscape in relation to PCA’s products and services.
- Strong attention to detail and ability to work with a high level of accuracy.
- Other duties as assigned.
