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Provider Network Director

Provider Network Director

Job ID 
2017-3866
Company 
PACE Consulting Solutions
Location 
US-PA-Johnstown
Posted Date 
10/17/2017
Category 
Management
Type 
Regular Full-Time
Education Level 
Bachelor's Degree
Experience Needed 
3-5 years
Salary Info 
Based on experience.

More information about this job

Overview

Provider Network Director

 

The Provider Network Director helps develop and maintain Senior LIFE’s network of physicians, hospitals, nursing facilities, pharmacies, ancillary groups and other healthcare providers that serve the complex needs of our Senior LIFE members. The position works under the direction of the Chief Operating Officer and is responsible for negotiating contracts that follow the operating guidelines and reimbursement parameters established by Senior LIFE. In addition, the Director provides oversight of contracted providers to ensure their compliance with all federal, state and local regulations, reimbursement standards, and other contract terms.

Responsibilities

Primary Responsibilities:

  • Identify quality providers in the Senior LIFE community and then initiate and finalize provider contracts with them.
  • Build strong relationships with members of the provider network and assist in addressing any provider related issues on a timely basis.
  • Conduct periodic site visits with the provider network members 
  • Work with the primary care team and the interdisciplinary  team to identify gaps in the provider network

 

Qualifications

To be considered for this position, applicants should meet the following qualifications:

  • Bachelor’s degree from an accredited college or university in an appropriate discipline
  • 4+ years of experience in a provider network management related role, such as contracting or provider services
  • In-depth knowledge of the Medicare inpatient prospective payment system (IPPS), the Medicare Physician Fee Schedule and other reimbursement methods
  • 4+ years of experience utilizing financial models and analysis in negotiating rates with providers
  • At least an intermediate level of knowledge of claims processing systems and guidelines
  • 3+ years of experience in performing network adequacy analysis

 

Preferred Qualifications:

  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
  • Strong interpersonal skills, establishing rapport and working well with others
  • Strong customer service skills

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