Network Operations Administrator (189263-955)

Description



Primary Function:

Experienced, detail-oriented individual to manage the physician network activities. Involving extensive interaction with Administrators, Provider Relations Representatives, Office Personnel, Physicians and Department Managers. This position will require a broad overview of managed care and the many aspects involved in effective management (financial review, network development, process development, etc.).

Responsibilities:

Network Financial Oversight

* Responsible for general oversight of network performance * Involvement in pro-forma budget preparation and implementation * Develop and implement monthly action plans. Participate in monthly financial reviews with senior staff * Review and adjust network specialist budgets according to changes in utilization * Verification of capitation checks, claims payments and financial information * Monitoring of Encounter Data; including submission in timely manner, completeness, and verification by office staff

Network Development

* Lead role in physician contracting, involvement in rate negotiations, follow up process * Build and foster network wide relationships (Health plans, vendors, etc.) * On-going communication with key physicians and Board of Directors * Identify through network management additional key providers, identify the appropriate contracting strategy and implement the contracting process * Recognition of recruitment needs through knowledge of physician community to identify possible candidates * Involvement with Hospital partners (reconciliation, etc.) through routine operations meetings Provider

Relations Development

* Provide clear management direction and assist in the career development of Provider Relations Representatives * Training responsibilities * Assist Provider Relations in leading and preparing the agenda for Team Meetings * Review Provider Relations' documentation to physician/office staff * Assist Provider Relations in conducting orientations/re-orientations

General Management

* Determine/communicate/resolve escalated office staff concerns * Recognition and resolution of network-wide issues * Resolve escalated member service issues/claims inquiries - assist Provider Relations to educate offices to ensure future compliance Required Skills



Supervisory Responsibilities: Leads one or more employees performing similar work Leads employees performing similar work on a project basis Manages through several layers of subordinate supervisors Manages employees (varied levels) across departments on a project basis *Supervises employees who do not supervise Supervises employees who supervise Supervises one or more supervisors Assigns and schedules work Conducts counseling and coaching Disciplines and/or terminates employees Hires or recommends hiring new employees Plans and evaluates employees' performance Promotes or demotes employees Provide on-the-job training Recommends or takes action upon review and checking of work Recommends or takes action affecting work loads or levels Recommends discipline and/or termination Staff Development/Team Building Required Experience



Required Education & Experience: *Bachelors Degree. Minimum of 4-8 years network operations experience with physician contracting P&L responsibilities. Employee management required. Healthcare experience required.