The Sr. Network Development Executive is responsible for identifying and evaluating opportunities, negotiating optimal reimbursement rates, and drafting contracts for an assigned provider network to ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations and MultiPlan policies, practices and procedures. In addition, the Sr. Network Development Executive is responsible for working with the Regional Director in the aggressive execution of regional strategies based on market trends and client expectations as well as continuing evaluation of the region’s network in terms of penetration and discounts.
1. Negotiate and execute provider contracts to support penetration and discount objectives relative to competitive market tends and client expectations through comprehensive, aggressive execution of region specific contracting goals.
2. Foster and maintain superior provider relationships.
3. May manage relationships with leased networks.
4. Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals.
5. Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends.
6. Ensure compliance with established policies and procedures and with regulatory requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources).
7. Serve as mentor to less experienced Provider Contractors through on-going instruction, coaching, modeling, and counseling aimed at developing the type of skills and behaviors that will result in successful resolution of provider contracting. Share provider contracting insights and information with less experienced contractors.
8. Work with Regional Sales and Account Management Peers to respond to and anticipate access requirements and network related performance guarantees. Use information derived from Requests for Proposals (RFP) to assess network adequacy and competitiveness in region.
9. Partner with HCE to conduct financial analyses and monitoring of marker trends to identify, develop, and implement competitive reimbursement.
10. Respond to provider questions, issues, and problems that have been appropriately escalated and produce a solution.
11. Provide support in facilitating education and training opportunities for contract team members.
12. Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources.
13. Demonstrate commitment to MultiPlan core values.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
The Sr. Network Development Executive is considered to be a senior/lead staff professional who knows and applies a comprehensive knowledge of principles, practices, and procedures related to the completion of complex or difficult negotiation and maintenance of provider network contracts. An incumbent works independently and has substantial latitude for unreviewed action or discretion and may have authorization to act outside standardized procedures, and provides assistance to less experienced Provider Contractor jobs in resolution of complex issues. An incumbent may act in a liaison capacity with other departments and may be called upon to evaluate progress and results as well as to recommend major changes in procedures. The Sr. Network Development Executive is expected to effectively communicate the MultiPlan Value Proposition. This job does not directly manage others but may be called on to provide project or work direction to less experienced Provider Contractors. The job may require overnight travel to meet with providers in assigned geographical or areas of responsibility.
• Minimum Bachelor’s Degree in related or applicable field, or equivalent experience related to network development
• Minimum 5 years experience in provider contracting and network development ( including contracting experience with a combination of physicians, physician groups, hospitals, and ancillaries), or equivalent provider/payer experience
• Knowledge and understanding of provider finance components including budget, charge structure, reimbursement formulas and healthcare finance
• Knowledge of provider organizations and operations applicable to assigned focus
• Knowledge of the provider community as a whole in the market areas including an understanding how the complex interrelationships between hospitals, physicians, ancillaries, etc work together as an entire system and the ability to app;y these components as leverage during negotiations as appropriate
• Knowledge of MPI integrated business model and its relationship to MPI clients and participating providers
• Communication, business acumen, analytical, negotiation, organization, and prioritization skills
• Ability to effectively negotiate rate structures and contract language that is compatible with MPI’s business model while limiting risk to MPI and its clients
• Ability to minimize non-standard language by thoroughly understanding our contracts is a must.
• Ability to elicit trust and credibility with all levels of the organization
• Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries
• Ability to build relationships with internal and external customers
• Ability to use computer software, hardware, and peripherals applicable to role
• Ability to understand and apply contract language of MultiPlan and of customer in order to minimize non-standard language changes
• Ability to understand relationships and structures of providers and competitors
• Ability to be comfortable with and to manage in-person client interface
• Ability to effectively communicate the MultiPlan Value Proposition.
• Up to 50% travel within assigned geographic area or region
As an Equal Opportunity Employer, MultiPlan will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.
MultiPlan Inc. - 22 months ago