Network Relations Manager - Massachusetts/Rhode Island

Acts as the primary resource for assigned profile of larger and more complex providers (i.e. market/ regional/national, large physician group or hospital systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

• Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.
• Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
• Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
• Supports or assists with operational activities that may include, but are not

limited to, database management, and contract coordination.

• Performs credentialing support activities as needed. Educates providers as needed to ensure compliance with contract policies and parameters, plan

design, compensation process, technology, policies, and procedures.

• Meets with key providers periodically to ensure service levels are meeting

expectations.

• Manages the development of agenda, validates materials, and facilitates external provider meetings.
• Conduct standard provider recruitment, contracting, or recontracting activities and assist with more complex contracting and discussions as needed by

business segment.

• May provide guidance and training to less experienced team members Required Qualifications

• 4+ years' experience in business segment specific environment servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.
• 3-5 years' experience with business segment specific policy, benefits, plan

design and language.

• Working knowledge of business segment specific codes, products, and

terminology.

• 1-2 years of Medicare and Commercial background

Preferred Qualifications