What are the responsibilities and job description for the Network Development, Medicare Advantage Plan position at Zyngeria HR?
We are currently seeking a proactive and skilled Network Developer in Mississippi to enhance our Medicare Advantage team. This position plays a critical role in establishing and maintaining a high-performing provider network, ensuring the delivery of exceptional healthcare services to our Medicare Advantage members. Your expertise will be invaluable in fostering relationships and collaboration within the network to achieve optimal outcomes.
Responsibilities :
Identify, negotiate, and secure contracts with healthcare providers to expand the Medicare Advantage network.
Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement.
Cultivate and sustain strong relationships with current providers, addressing any issues or concerns promptly.
Directly responsible to analyze and interpret data in government value-based reimbursement reports in the areas of Medicaid HEDIS and risk revenue and develop strategic plans to meet PCP government program targets to create value, impact, and cost savings, as well as meeting the ROI as identified by the Organization
Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources.
Evaluate network performance and implement strategies to improve access, quality, and cost-effectiveness.
Ensure adherence to all regulatory requirements and company policies.
Work closely with internal teams to support network development initiatives and resolve provider-related issues.
Stay informed about market trends and competitor activities to identify opportunities for network expansion
Leads the markets strategy and planning in the successful development of the provider network, including development, contracting and management of provider relationships and communications
Qualifications :
5 years in Medicare / Medicaid and risk revenue, primary care and the ambulatory care environment, healthcare insurance industry government programs, healthcare administration in primary care, or healthcare consulting in government programs for primary care
Knowledge and understanding of finance provider components including budget, charge structure, reimbursement formulas and healthcare finance
Strong analytical skills and strategic planning capabilities.
Exceptional organizational and project management skills.
Excellent negotiation and communication skills.
Required licensures, professional certifications, and / or Board certifications as applicable
Comprehensive knowledge of Medicare Advantage regulations and guidelines.
Knowledge of provider network adequacy requirements for Medicare Advantage and / or Department of Insurance network requirements for commercial Health Plans and Medicaid Managed Care Plans.
Diversity, Equity, Inclusion & Equal Employment Opportunity at Zynergia HR :
Zynergia HR is committed to an inclusive, diverse, and equitable workplace, and is further committed to providing equal employment opportunities regardless of any protected characteristic including : race, color, genetic information, creed, national origin, religion, sex, affectional or sexual orientation, gender identity or expression, lawful alien status, ancestry, age, marital status, protected veteran status, or disability. Hiring decisions are based upon Zynergia HRs operating needs, and applicant merit including, but not limited to, qualifications, experience, ability, availability, cooperation, and job performance.
Job Type : Full-time
Pay : $50,000.00 - $120,000.00 per year
Benefits : 401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance
Schedule : 8 hour shift
Day shift
Monday to Friday
Education : Bachelors (Required)
Experience :
Medicare / Medicaid Advantage Plan : 5 years (Required)
Location :
Mississippi (Required)
Work Location : Remote
Salary : $50,000 - $120,000