ABOUT THE ROLE:

As a member of the Network Development team, the Network Development Coordinator plays a critical role in implementing the organization’s provider network strategy by collecting and analyzing market intelligence, preparing provider contracts in the contract management system, responding to provider inquiries, and providing overall support to the contracting process. The ideal candidate should be highly organized and possess excellent analytical skills, have strong attention to detail and experience in payor-side, provider contracting.

RESPONSIBILITIES:

Network Development:

• Conduct market analysis and provider outreach to identify and catalog potential provider targets and relevant data elements.
• Work closely with contract negotiators to build provider agreements in the contract management system in accordance with defined parameters.
• Complete quality checks on executed provider contracts in the contract management system prior to releasing provider contract data to downstream systems.
• Ensure the accurate and timely implementation of provider contracts, paying special attention to meeting NCQA, HEDIS, Federal, State, and other regulatory requirements.
• Conduct network analysis to ensure compliance with network adequacy standards.
• Identify and contribute to contracting process improvement including communicating contract management improvement requirements.
• Build and monitor contract data dashboards to show contracting progress across geographic markets and compliance with organizational KPIs.

Provider Engagement:

• Respond to and/or triage provider inquiries related to network participation, enrollment procedures, demographic updates, and overall provider participation requirements.
• Support the organization on timely provider feedback loops between multiple internal teams.
• Build and monitor provider dashboards to show the volume provider inquiries and the organization’s timeliness for resolving them.

Internal Facilitation:

• Collaborate with internal teams to streamline network operations, resolve provider-related issues, optimize network efficiency and effectiveness, and ensure alignment and coordination in network-related initiatives.
• Coordinate with internal teams to ensure provider presentation materials are delivered, quality checked, accepted.
• Foster a culture of collaboration, innovation, and continuous improvement.

Compliance:

• Support the completion of annual Accreditation (i.e. URAC or NCQA) and/or state-required reports and filings in collaboration with key stakeholders.
• Initiate, track, and update on a regular cadence: network development policies and procedures.

EXPERIENCE and EDUCATION REQUIRED:

• Bachelor’s degree or equivalent experience preferred.
• A minimum of four (4) years of experience in network development or provider contracting role.
• Understanding of provider contracting and provider relations, as well as network operations, including data management, credentialing, contract management, and claims processing.
• Highly organized and possess excellent analytical skills with a strong attention to detail.
• Demonstrated ability to work in a fast-paced, evolving environment while managing multiple priorities.
• Strong verbal and written communication skills.

KEY PERSONAL AND PROFESSIONAL ATTRIBUTES:

Accountability: 

• Ability to work collaboratively internally and externally
• Self-assured, self-directed, and results oriented

Critically Thinking:

• Strong analytical and abstract problem-solving skills
• Lifelong learner, ability to learn new skills as the organization needs

Change Champion:

• Commitment to the startup
• Build Relationships
• Effective communication