Network Management Specialist, National Ancillary Contracting
Location: Orange, California US
Job Number: 1319
Position Title: Network Management Specialist
The Network Management Specialist, National Ancillary Contracting will assist in building and maintaining high-performance provider networks by identifying opportunities to contract with providers, improve the contractual performance, and enhance the provider’s experience with AHC.
(May include but are not limited to)
- Supplemental vendor negotiations and management to assist all Regional Markets.
- Responsible for the negotiation of cost effective ancillary contracts and maintenance of ancillary networks as requested by the Regional Markets.
- Build strategic and collaborative partnerships with ancillary and/or supplemental providers.
- Ancillary support for all Regional Markets. Provide ancillary contracting guidance and function as the subject matter expert in ancillary contacting for all Markets.
- Upon request of a specific Regional Market, supports efforts to improve Regional Market financial performance by negotiating cost effective ancillary contracts that will be utilized by the Regional Market, evaluating the ancillary contract’s performance, identification, analysis and resolution of problem areas, communicate to the Regional Network staff key ancillary contract to improve the Regional Market’s performance.
- As requested, assist with the negotiation of ancillary provider letters of agreements.
- Prepares supporting documentation, negotiates and implements contracts for ancillary providers for both existing and developing markets.
- Enhances the relationship with ancillary providers by providing appropriate data sharing, efficiently and effectively responding to requests for information, and by successfully resolving issues related to capitation, claims, and other operational functions.
- Utilizes understanding of the business risk relationships to interact and influence ancillary provider, and identify key types of ancillary contracts that need to be negotiated.
- Maintains timely internal awareness of network changes by issuing timely and accurate provider update communications about contractual arrangement changes, provider terminations, changes and additions.
- Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and timeframes.
- Promotes enrollment growth by supporting Marketing & Sales Department, as needed.
- Supports department efforts and Network Management Manager by participating in interdepartmental meetings and selected committees.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
- Contributes to team effort by accomplishing related results as needed.
- Other duties as required.
- Minimum Experience:
- Minimum 5+ years’ experience in provider relations/contracting with an HMO or IPA, medical group or institutional provider required.
- Knowledge of ancillary and supplemental provider rate structures and rates.
- Proficient in Microsoft Office, including Outlook, Word and Excel.
- Bachelor’s Degree preferred.
- Strong analytic, quantitative, and problem-solving skills required.
- Strong verbal and written communication skills required.
- Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
- Proficiency in MS Word and Excel required; Access database proficiency preferred.
Conditions of Work
- Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
- Travel by plan required as needed to support provider services needs in other geographies.
- Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Location City: Orange
Location State: California
Community / Marketing Title: Network Management Specialist, National Ancillary Contracting
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact firstname.lastname@example.org.