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Ewings Associates, Inc. Healthcare Provider Network Development Consultant in San Antonio, Texas

Reference # :19-00132Title :Healthcare Provider Network Development ConsultantLocation :San Antonio, TXExperience Level :Start Date :01/01/2020 Description* Hiring for this position has paused. We encourage you to apply, as we would like to consider you for future openings. * EWINGSis in search of Senior Network Development Consultants for a new exchange build in select Texas markets. Highlights:

  • Initial contract period through 12/31/20, with potential renewal.

  • Target markets: Austin, San Antonio, Lubbock, El Paso, Houston, DFW

  • Primarily telecommute, 10-20% travel on an as needed basis to meet with providers

    We are interviewing now – don't miss your opportunity to be considered! Apply now atwww.ewingsinc.comPreferred candidates are in or near the target markets and possess existing relationships with providers in that area. Network Development Position Description:

  • Develop a commercial exchange provider network with physicians (solo, group, IPA), ancillary, and DME groups that is competitive and provides broad healthcare access to patients.

  • Build a stable provider network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product.

  • Use recruitment tools, data, and facts to identify and solve network-related problems and develop contracting tactics within your assigned area.

  • Investigate non-standard network requests and manage a wide range of provider Tricare network issues

  • Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.

  • Establish relationships with healthcare providers to ensure the network composition includes an appropriate distribution of provider specialties.

  • Provide contract explanations and interpretations within your expertise.

Qualification Requirements:

  • Undergraduate degree or experience equivalent

  • Minimum of 5 years of Texas market experience in ahealthcare network development,network contracting,provider services,provider contracting.

  • In-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS).

  • 7+ years of experience in network fee schedule development.

  • 7+ years of experience utilizing financial models and analysis in negotiating network rates.

  • Intermediate level of knowledge of claims processing and guidelines.

  • 7+ years of experience in performing network adequacy and network gap analysis.

  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying contract or technical information in a manner that others can understand, as well as the ability to understand and interpret complex information from others.

  • Strong interpersonal skills, establishing rapport and working well with others.

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