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Network Relations Specialist

1 hour, 36 minutes ago
United States
Full-time
Senior
Account Manager
Sales and Business Development
Salesforce
Apply Now
Evry Health

Evry Health

Evry Health is a modern health insurance company that prioritizes delivering great benefits at affordable prices. They offer a unique approach to health insurance by focusing on making members healthier and happier through personalized care from a dedi...

Insurance
11-50
Founded 2017
$7M raised
View All Jobs 4

Description

  • Develop an adequate provider network across assigned geographic markets.
  • Negotiate and renegotiate contracts with physicians, provider groups, facilities, and ancillary providers.
  • Collect roster updates and standardize information with Analytics and IT teams.
  • Coordinate effective dates and credentialing notifications with the credentialing CVO.
  • Maintain network compliance with regulatory time, distance, and choice requirements.
  • Build and maintain relationships with contracted providers and respond to contract and roster inquiries.
  • Run and monitor reports to ensure compliance requirements are met and identify network gaps.
  • Maintain accurate records in Salesforce or a similar contract tracking system.
  • Report network status, risks, and opportunities to leadership on a regular basis.
  • Compile and analyze provider and hospital fee schedules with analytics and actuarial teams to support benchmarking and medical economics reporting.

Requirements

  • 5+ years of experience negotiating provider contracts, including physician and provider group contracts.
  • Experience negotiating commercial contracts with hospital systems and provider groups.
  • Experience with multiple payment methodologies, such as percent of Medicare, RBRVS, ICD or similar code sets, case rates, and DRG.
  • Experience discussing value-based or risk-based contract parameters.
  • Analytical experience, including SERFF reporting of network adequacy.
  • Experience with Salesforce or a similar contact management system.
  • Excellent verbal and written communication skills.
  • Ability to develop and maintain effective working relationships.
  • Bonus: experience in multi-state or national provider contracting.
  • Must live in the United States and have access to a dedicated private work area with high-speed internet.

Benefits

  • Remote position with a fully distributed company.
  • Company headquarters in Dallas, Texas.
  • Business hours are weekdays 9-5 CST.
  • Full benefits package including health insurance, vision, dental, life, and disability coverage.
  • 401(k) matching.
  • Vacation time.

Interested in this position?

Apply directly on the company website

Apply Now

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