Network Relations Specialist

About the Role

Evry Health, a Globe Life company, is seeking a Network Relations Specialist. In this role, you will lead the development and management of a geographic medical network for our health plan. You will negotiate, review and amend contracts with physicians, physician groups, facilities, and ancillary medical providers. We are big believers in partnering for improved medical quality, so contracts may be value-based. You will also be responsible for monitoring and reporting network adequacy and network quality.

About Evry Health and Globe Life

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.

Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

Responsibilities

• Development of an adequate provider network within assigned geographic markets. Includes Negotiating and renegotiating contracts with physicians and provider groups and facilities
• Responsible for collecting roster updates and standardizing information received with Analytics and IT teams
• Tracking and coordinating notification of effective date with the credentialing CVO
• Maintenance and management of the network in accordance with regulatory time, distance and choice requirements
• Building and maintaining relationships with contracted providers, including responding to inquiries related to contract status, roster corrections and matters related to information accuracy
• Routinely running and monitoring of various reports to ensure all necessary compliance requirements are being met and maintained, and identifying targets to address emergent gaps
• Accurate maintenance of Salesforce or similar contract tracking and activity system
• Reporting to leadership the current status, risks, and potential opportunities in area of responsibility on a regular basis
• Working with analytics and actuarial team(s), compile and analyze provider and hospital fee schedules to benchmark against goals and assist with the medical economics reporting
• Performs other duties as required

Qualifications

• Experience negotiating commercial contracts with hospital systems, provider groups
• 5+ years negotiating provider contracts including physician / provider group contracts with multiple payment methodologies, e.g. percent of Medicare, RBRVS, ICD or similar code set, case rates, DRG, as well may include discussion of value based/risk parameters
• Analytic capabilities, including experience with SERFF reporting of network adequacy
• Experience with Salesforce or similar contact management system
• Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.
• Bonus: Experience in multi-state or national provider contracting

Telecommuting Requirements

• Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
• Ability to keep all company sensitive documents secure.
• Must live in the United States.
• Must live in a location that receives an existing high-speed internet connection/service.

Location and Benefits

• This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
• Company business hours are weekdays 9-5 CST.
• Full benefits package including health insurance, 401(k) matching, vision, dental, life, disability, and vacation.

Originally posted on Himalayas