Senior Analyst, Network Relations

Description:

• The Medicaid Network Provider Relations Manager oversees our Medicaid Provider Experience programs
• Acts as the primary contact for an assigned profile of larger and more complex providers
• Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth and efficiency targets
• Research and handle contract related issues
• Claims research related to provider set up issues, payment resolutions
• Facilitate JOCs and webinars, provider orientations/visits, provider training, state projects
• Create and manage provider-facing communications
• Collaborate with Quality Management and VBS team
• Coordinate with Network Management to issue provider CAP
• Monitor Grievances according NCQA standards categories
• Document visits/encounters in the appropriate systems

Requirements:

• Excellent interpersonal skills and the ability to work with others at all levels
• Minimum of 2 years’ experience with Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
• Excellent analytical and problem-solving skills
• Strong communication and presentation skills
• 3+ years' experience in Medicaid Managed Care business segment environment with exposure to benefits and/or contract interpretation
• Working knowledge of business segment specific codes, products, and terminology

Benefits:

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access

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