Responsible for analytical review of provider network performance for active, as well as, prospective Clients. Develop and maintain a close working relationship with the internal departments for implementation and operation of new and current Client contracts
Essential Functions & Responsibilities
- This position requires strong analytical skills to thrive in a fast paced environment as well as be comfortable with management exposure.
- Analyze the claims utilization and cost performance of the specialty networks.
- Analyze the claims utilization data provided by prospective Clients.
- Review network accessibility (including quarterly geo-map analysis).
- Complete cost and quality metrics and report outcome to senior management and other departmental staff.
- Network oversight of adjudication of Claims by TPA.
- Maintain strong working relationships with Network Managers, acting as their key support in reviewing provider network performance.
- Provide tactical support and recommendations to network contracting team by assisting with analyses, projects, etc. Supports negotiation and contract interpretation and compliance.
- Act as a liaison between Networks and TPA departments for assistance and operations of contractual obligations of Networks to its Clients.
- Work on various special projects and ad-hoc reports on an as needed basis.
- Develop and maintain familiarity with the managed care industry, such as availability of outside sources of information, statutes affecting HN1 business, current industry trends, and general services/locations of major non-contracted providers.
- Attend all staff and committee meetings as requested by the Vice President of Network Operations and/or President & COO, including evening quarterly Executive Committee Meeting.
Required Education and Experience
- Bachelor's degree or equivalent data analysis experience.
- Two or three years background in the managed care industry.