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.
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.