Provider Network Executive

Summary

A provider network professional is responsible for managing relationships between healthcare providers and health plans or insurance companies. They recruit new providers, negotiate contracts, ensure compliance with quality standards, and address provider concerns. Their role involves analysing performance data, coordinating care, supporting provider needs, and strategizing network expansion to enhance service offerings. Effective communication, negotiation skills, and a deep understanding of healthcare systems are essential for success in this role.

Job Responsibilities:

• Network Development: Reach out to providers that are requested by our corporate clients – Cold calls. Negotiate/Explain contract terms and rates with providers to ensure they fully understand our terms and condition before signing the agreement.
• Relationship Management: Build and maintain strong relationships with existing network providers. Act as the primary point of contact for providers, addressing their inquiries and resolving any issues.
• Compliance and Quality Assurance: Ensure that all providers comply with company policies, industry standards, and regulatory requirements. Monitor provider performance and service quality, addressing any concerns promptly.
• Data Management: Maintain accurate and up-to-date records of provider contracts, communications, and performance data. Ensure that all documents are stored properly in SharePoint folders.
• Reporting and Analysis: Prepare regular reports on network performance, provider issues, and market trends.
• Stakeholder Collaboration: Work closely with internal teams such as claims, customer service, customer success and finance to ensure seamless operations between the company and the providers.

Job Requirements:

• Bachelor’s Degree in healthcare administration, business, or a related field are preferred.
• Experience in healthcare management, provider relations, or a similar field is often preferred, though entry-level positions may accept less experience.