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Provider Network Specialist

2 months ago

Clinton Township, United States Birdsong Hearing Benefits Full time
Overview:

Want to apply Read all the information about this position below, then hit the apply button.
The role of Provider Network Specialist is a key role for Your Hearing Network (YHN). This role is essential to ensure the highest quality of provider relationships and provider recruitment to grow the network. The role reports to the Chief Operating Officer (COO) of Birdsong Hearing Benefits, a sister company to Your Hearing Network. The COO also has responsibility for the YHN provider relations and recruitment operations.

As a Provider Network Specialist for Your Hearing Network, this strategic role plays a crucial part in ensuring our members have access to high-quality hearing care services. Key functions of this role will include provider relations and provider recruitment. This dual-role position focuses on expanding the network of providers while ensuring that existing providers are well-supported and meet the company's NCQA quality standards. The Provider Network Specialist will identify potential providers, assist in contract negotiations, facilitate the onboarding process, and ensure appropriate growth and retention of the network. Additionally, the role will maintain ongoing relationships with network providers, address any concerns and ensure proper compliance with company policies, NCQA standards, and industry regulations.

Key responsibilities include network expansion through strategic recruitment efforts, managing provider relationships, retention, ensuring compliance with credentialing NCQA standards, and collaborating with internal teams to align network development with organizational goals. This role requires strong, crisp communication, experience in negotiation, and relationship management skills, and seasoned experience in the healthcare or hearing care industry.

Responsibilities:
ESSENTIAL JOB FUNCTIONS
Key Accountability for Provider Relations
Network Management:
- Develop, implement, and manage strategies for expanding and optimizing the hearing care provider network.
- Establish and maintain relationships with hearing care providers, including audiologists, ENT specialists, and hearing aid dispensers.
- Monitor provider performance and service quality to ensure adherence to organizational standards and patient care expectations.
Provider Support:
- Serve as the primary point of contact for network providers, addressing their inquiries and resolving any issues.
- Provide training and support to providers on organizational policies, procedures, and systems.
- Coordinate with providers to ensure timely and effective communication regarding network updates and changes.
Data Management:
- Collect, analyze, and report on data related to network performance, provider metrics, and patient outcomes.
- Utilize data insights to identify trends, areas for improvement, and opportunities for network growth.
- Maintain accurate and up-to-date records of provider information, agreements, and performance evaluations.
Compliance and Quality Assurance:
- Ensure that network providers comply with relevant regulations, accreditation standards, and best practices in hearing care.
- Conduct regular audits and evaluations of provider services and facilities to ensure high-quality care.
- Address any compliance issues promptly and work with providers to implement corrective actions.
Collaboration and Coordination:
- Work closely with internal teams, including clinical, operations, and customer service, to align network strategies with organizational goals.
- Collaborate with internal stakeholders, to enhance network capabilities and patient access to care.
Reporting and Documentation:
- Prepare and present regular reports on network performance, provider metrics, and strategic initiatives to senior management.
- Document network activities, provider interactions, and key performance indicators to support continuous improvement efforts.

Key Accountability for Provider Recruitment
Network Recruitment:
- Identify and reach out to potential hearing care providers through various channels (e.g., cold calling, emailing, networking events).
- Present the benefits of joining the hearing network to prospective providers.
- Secure contracts with providers to ensure mutually beneficial terms.
Network Expansion:
- Develop and implement strategies to expand the network in targeted geographic areas.
- Build heat maps, focusing on closing gaps in current network, and driving strong reach into rural areas. State by State review of network, along with key strategies of provider acquisition required of this role
- Conduct market research to identify gaps in the network and areas for growth.
- Collaborate with internal teams to align recruitment efforts with company goals.
Relationship Management:
- Build and maintain strong relationships with existing and prospective providers.
- Serve as the main point of contact for providers during the onboarding process.
- Address provider concerns and ensure a positive experience throughout their partnership with the network.
- Strong emotional intelligence, ability to sort through information, make strategic decisions, and keep team abreast of changes are all important components of competence.
Compliance & Quality Assurance:
- Ensure all recruited providers meet the NCQA credentialing and quality standards.
- Work with the compliance team to ensure all contracts and agreements adhere to legal and regulatory requirements.
Reporting & Analytics:
- Track and report recruitment activities, providing regular updates to management.
- Analyze recruitment data to identify trends, challenges, and opportunities for improvement.
Experience with software used for network growth is preferred

Qualifications:
PROFESSIONAL EXPERIENCE/QUALIFICATIONS

Requirements and Must-Have Criteria
- Three (3) years’ experience preferred in provider relations and/or provider recruitment.
- experience working with healthcare providers, understanding their needs, and building strong relationships.
- familiarity with managed care principles is valuable.
- Strong verbal and written communication skills.
- Preferred experience in provider contracting and negotiations.

Other Personal Characteristics and Experience
- Demonstrate an entrepreneurial spirit, understanding start-up requirements, managing change well, and being flexible to environment.
- Willingness to go above and beyond daily to achieve best-in-class results.
- Ability to work with highly detailed, complex, and emotionally sensitive information.
- Ability to maintain a high degree of discretion, confidentiality, protection, and integrity.
- Ability to prioritize and complete multiple complex work assignments.
- Ability to work independently.
- Excellent written and verbal communication skills.
- Ability to provide constructive feedback in a clear, concise, and respectful manner.
- Demonstrate ability to meet deadlines.
- Basic knowledge of data analysis, statistics, data integrity, and analytics with initiative and ability to further develop skills.

EDUCATION
- Bachelor’s degree in healthcare administration, or related field is preferred. Equivalent work experience will be considered in lieu of a degree.

competencies
- Demonstrate high proficiency skills in MS Office applications.
- Negotiation Skills: Provider Network Specialists often negotiate contracts with healthcare providers. Strong negotiation skills are vital.
- Communication and Relationship-Building: Excellent communication skills are necessary for collaborating with providers, addressing concerns, and maintaining positive relationships.
- Relationship Building: Ability to establish and maintain strong relationships with providers and internal stakeholders.
- Strategic Thinking: Ability to develop and execute strategies to grow the provider network effectively.
- Attention to Detail: Ensure all provider agreements and compliance requirements are thoroughly reviewed and met.
- Problem-Solving: Capable of identifying issues and implementing solutions promptly.
- Multi-Tasking: Provider Network Specialists handle various responsibilities simultaneously, so effective time management and multitasking abilities are essential.

Attitude and approach
- Collaborative Mindset: Success in this role depends on working well with cross-functional teams, including claims, customer service, and management.
- Problem-Solving: Ability to address challenges related to network performance, member complaints, and provider satisfaction.
- Member-Centric Focus: Always keep the well-being of our members at the forefront.
- Innovation: Be flexible and nimble, slight changes can have a large effect -- work smarter, not harder.
- Team: We are better together, celebrate our successes, learn from our mistakes, we all help each other develop and grow through open dialogue and feedback, our efforts are interconnected, and our diversity makes us stronger.
- Accountability: To oneself and others, you positively affect someone's life, you hold yourself and your team accountable, find learning moments in every experience

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