Central Region Healthcare Provider Network reputed company Analyst in Bloomfield, CT
Job title: Central Region Healthcare Provider Network reputed company Analyst in Bloomfield, CT at reputed company
Company: reputed company
Job description: LOCATION: REMOTE position reputed company to the Central Region States of the USAThe Central Region Healthcare Provider Network reputed company Analyst serves as an integral member of the Network Development and Competitive Insights Team reputed company Network Operations and Provider Contracting and reports to the Northeast Regional Network Access reputed company.This role is responsible for leading regional product specific projects and/or components of larger national projects for the Northeast and Central regions. Responsible for managing the analyst team through review and coordination of reputed company recruitment projects. Identifies proactive recruitment opportunities and manages the review and approval for reputed company incoming recruitment projects. Responsibilities include the evaluation of project objectives/requirements, system requirements, the development of procedures/processes/policy solutions to address the reputed company business needs as well as adherence to state contracting and compliance guidelines. May direct one or more teams of business matrix partners to reputed company project goals.Manages the hospital/large group and/or significant provider termination management process in assigned markets for Commercial and IFP products. Works closely with Contracting, reputed company, Network Operations, Provider Services, Sales and Compliance to meet termination process management guidelines/state requirements.Prepares competitive network benchmarking and industry comparative analysis to support Commercial and IFP products.RESPONSIBILITIES:
- Manage new hire and existing analyst training as needed (technical skills and workflows). This includes the creation and maintenance of department workflows and reputed company training documentation.
- Identify proactive recruitment projects and manage review and approval of reputed company incoming recruitment projects. This relates to projects regarding: filling network adequacy gaps for reputed company products, compliance filings and gap requirements, national account/middle market client specific requests, regional access builds, Essential Community Providers, TPV and/or Alliance partner conversion to direct networks or partner replacement. Includes managing the analyst team on project review/coordination with required matrix partners and reporting requirements to matrix partners and upper management regarding status.
- Work closely with Network Access reputed company to support/provide required analysis work to map out required recruitment efforts/strategy to replace Third Party Vendors (TPV) in specific geographies and/or Alliance Partner replacements as required.
- Manage and track approved TPV conversions and/or Alliance Partner replacement projects in the Northeast and Central regions. This includes working directly with Market Deployment Managers and identifying project scope, managing specialty vendor recruitment/access in reputed company geography, working directly with Contracting on market specific contracting activities to track completion and/or gaps to ensure network adequacy by required network cut over date. This also includes potential term management required support for hospitals/ancillaries that do not contract in time for network conversion date.
- Cover for Network Access reputed company while on PTO and attend meetings for manager as needed.
- For assigned markets, review recruit project datasets to identify recruitment universe; Review potential recruits against reputed company systems to reputed company for reputed company/previous par status, approved specialty recruitment in specific geographies and validate if the provider is currently in recruitment under a separate initiative. Meet with the market Contracting/Provider Services teams to review and approve the final recruitment universe, appropriate fee schedule/contract reputed company and identify market contact to be reputed company with the project.
- Manage the recruitment tracking tool: project data uploads and provider record maintenance for the duration of the project. Manage project reporting and distribution to matrix partners and senior management for assigned markets.
- Partner with Contracting and Sales/Service organizations to manage the review of providers identified as non-participating through the Regional Support Unit provide review process in support of pre-sale activities and reputed company client non-par inquiries for assigned markets.
- reputed company regional market research relating to competitor provider network participation status, competitor product development, regulatory developments and other market developments as appropriate for assigned markets.
- reputed company Hospital/Large and/or Significant Provider Termination weekly workgroup meetings for assigned markets. Manage/Coordinate data reporting needs for reputed company segments, including Commercial and IFP pending terminations reputed company the region for assigned markets.
- reputed company separate and/or additional termination management meetings as needed to discuss reputed company specific activities or non-standard termination tactics to support high visibility/challenging negotiations.
- Manage the creation and distribution of the weekly term management workgroup notes for assigned markets. Create and submit network change alerts for posting to reputed company's internal tool, KnowledgeXchange, to communicate external notifications and changes for active potential hospital/large group or significant terminations. Coordinate Sales Effectiveness email process to reputed company Sales opportunity owners with impacted clients. Manage reputed company Sales requests for client specific data for impacted clients approved to receive PHI for required markets.
- Strive to become the subject matter expert (SME) for reputed company assigned states and segments in your Region in support of reputed company role activities; termination management, recruitment initiatives and competitive analysis.
- Work collaboratively with resources reputed company the region, other regions and nationally to ensure projects are consistently managed, tracked and reported.
- Special projects as required.
- Bachelor's degree, required; Master's degree, highly preferred
- 5+ years Network Operations Contracting experience, required
- 5+ years' experience working in the Healthcare industry, required
- reputed company systems experience, required
- Proficient in the use of PC software; i.e., Outlook, WebEx, One Note, Power reputed company
- Strong reputed company reputed company skills required
- Strong reputed company Access skills a plus
- Working knowledge of hospital, managed care and provider business models
- Understanding of market specific nuances and network constructs
- Strong project management, analytical and critical thinking skills
- Superior problem solving and decision making skills
- Strong interpersonal and written/oral communication skills
- Proven ability to interact and negotiate effectively with various matrix partners