Medicare Network Specialist-1

EDUCATION

Bachelor's degree in Health Sciences, Health Care Administration, Business Management or related field. In lieu of degree, five (5) years' experience in Network Management/Network Development, Provider Relations, Risk and/or Value Base Contracting will be considered.

Master's degree preferred.

EXPERIENCE

Minimum five (5) years' experience in Network Management, Provider Relations, Risk and/or Value Base Contracting with a managed care organization.

Prior experience in professional Physician engagement and relationship management.

Experience managing and negotiating major provider contracts.

In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers.
Knowledge of regulatory requirements with emphasis on Medicare.
Working knowledge of provider issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.

Minimum three (3) years' experience working in Medicare Advantage, Medicare Part D, Medicare Start Ratings, or Medicare required.
Experience with Medicare Advantage STAR rating initiatives and health coaching preferred.

Experience with Content Management Systems preferred.
Experience with value based and global risk contracting preferred.
Direct knowledge of Medicare global risk, value-based, and fee-for-service contracting preferred.

ESSENTIAL SKILLS & ABILITIES

Effective project and change management skills
Ability to use query tools for research and analysis.
Ability to develop and mentor others.
Ability to assume broader organizational responsibilities as needed.

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.