Hospital Network Specialist

HEALTH PARTNERS is the Philadelphia area’s only health plan that’s owned by a partnership of local hospitals and health systems.  We continually strive to improve the health outcomes of our members, building a healthier community in the process. Our corporate commitment to operate with respect and dignity in all relationships stands behind everything we do.  We offer excellent benefits, competitive salaries and a great 401(k) Plan.

GENERAL DESCRIPTION:  Relationship owner for assigned list of hospitals, including all provider service functions, and participation in contracting process. Specialist also performs assigned analyses of hospital and contract performance, compiles reports for regulatory agencies, and monitors compliance of standard provider contracting with CMS, DPW, and NCQA requirements.

KEY REQUIREMENTS:  Minimum Bachelors Degree in Business Healthcare or related Liberal Arts discipline, with coursework in Health Care.  2-3 years of experience in a managed care setting (payer or provider based) with exposure to provider reimbursement; experience with provider customer service and claims payment. superior organization, personal interaction, and follow-up skills. Excellent written and oral communication skills. Strong quantitative analytic abilities.  Careful attention to detail.  Intermediate to advanced use of Microsoft Excel and Word, knowledge of hospital payment methodologies, including case based, per diem, etc., sufficient to analyze cost experience. Familiarity with claims payments processes. Ability to use MHS. Knowledge of Microsoft Access desirable.

PRIMARY RESPONSIBILITIES:  As directed, prepare contract and rate analyses, recommends rate proposals, participate in rate and language negotiations, and recommends language for contract changes. Works with other to departments to implement new contracts and changes both accurately and on a timely basis. Notifies and describes contract changes to other departments, interprets provider agreements. Calculates scheduled rate increases, obtains hospital concurrence, and implements changes with other departments.  Responds to hospital inquiries for assistance. Provide customer service; coordinate with HP departments ( e.g. UM, Claims) to resolve issues ( including identifying recurring and systematic issues; recommending changes), Complaint & Grievance responses, trouble shooting, responding to concerns and questions, assisting with re-credentialing as needed. Conduct periodic meetings with hospital and HP staff to review operations and resolve issues.  Assisting in developing and refining measures (“Dashboardâ€�) for review of operations and trends for each hospital(s)/ health system(s).in Health Partners’ network.. Prepare and analyze data on ongoing basis. Coordinate internal review meetings with other departments.  Timely and accurate maintenance of informational tables/grids/listings  about the Hospital and Ambulatory surgery network used by other departments: e.g. UM grids, UMC Summary, Contract Summary grids, Contract Calendar, Exhibit A database (services by hospital).  Working with Quality Management, coordinate and conduct annual hospital and ambulatory surgery center provider satisfaction survey, including: development and monitoring of work plan; development of questionnaire and sampling; distribution of questionnaire; tracking and following up to encourage high response rate; data entry, validation, & statistical analysis, coordinate distribution of incentive gifts to responders. Assist with Ancillary Annual Provider Satisfaction survey. Compile edit and, upon approval, submit assigned regulatory reports describing the hospital network and contracts.  Serve as departmental representative/participant on interdepartmental work groups/task forces as assigned.  Perform other duties as assigned.