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Healthcare Network Development Specialist

2 months ago

MagstattleBas, Grand Est, United States Nebraska Total Care Full time
Job Summary

We are seeking a highly skilled and experienced Healthcare Network Development Specialist to join our team at Nebraska Total Care. As a key member of our organization, you will play a critical role in developing and maintaining strong relationships with healthcare providers, driving quality and financial outcomes within our network.

Key Responsibilities
  • Provider Orientations and Educational Outreach: Conduct initial provider orientations and ongoing educational sessions to enhance provider knowledge and understanding of our health plan policies and procedures.
  • Policies and Procedures Education: Educate providers on policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface.
  • Account Relationship Enhancement: Investigate, document, and resolve provider matters, and effectively handle and respond to account changes and correspondence.
  • Patient-Centered Medical Home Initiatives: Engage providers and educate them on Patient-Centered Medical Home initiatives to improve quality and patient outcomes.
  • Performance Analysis and Reporting: Perform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create reports for provider review, highlighting both quantitative metrics and qualitative factors.
  • Milestone Documentation and Communication: Create and communicate milestone documents, dashboards, and success or improvement metrics to stakeholders.
  • Liaison and Coordination: Act as a liaison between the provider and the health plan, ensuring a coordinated effort to improve financial and quality performance.
  • Incentive Agreement Updates: Provide information and status updates for providers regarding incentive agreements.
  • Site Visits and Contracting Duties: Conduct site visits when required and perform other contracting duties as requested, including recommending changes to pricing subsystems, submitting changes to provider-related database information, and assisting in the completion of special projects.
  • Travel Requirements: Ability to travel locally 5 times a month minimum.
Requirements
  • Education and Experience: Bachelor's degree in a related field or equivalent experience. 2+ years of combined managed healthcare and provider reimbursement experience. Claims processing and/or managed care experience preferred.
  • Licenses and Certifications: Current state driver's license.
  • Residency and Travel Requirements: Candidates must reside in the state of Nebraska. Ability to travel locally 5 times a month at minimum is required.
Benefits

We offer a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules.