Job Summary: The Network Consultant is responsible for supporting the development, maintenance, and optimization of the healthcare provider network. This role involves managing provider relationships, ensuring compliance with contractual obligations, and assisting in the resolution of provider-related issues. The Network Consultant will work closely with internal teams and external providers to enhance network efficiency and service quality.

Key Responsibilities:

1. Provider Relationship Management:

•  Act as the primary contact for providers, addressing their inquiries and concerns.
• Develop and maintain strong relationships with network providers to foster cooperation and satisfaction.
•  Assist providers with onboarding, training, and ongoing support.

2. Contract Management:

• Assist in the preparation, review, and management of provider contracts.
• Manage the contract renewal process and address any issues that arise.

3. Network Maintenance and Optimization:

• Maintain accurate and up-to-date provider information in the network database.
• Monitor network adequacy and identify gaps to ensure sufficient provider coverage.
• Track and report on provider performance metrics.

4. Issue Resolution:

• Identify and resolve issues related to provider claims, payments, and compliance.
• Escalate complex issues to the Provider Network Manager or other relevant departments as needed.

5. Regulatory Compliance:

• Ensure the network complies with all relevant federal, state, and local regulations.
• Assist in implementing company policies and procedures related to network management.

6. Reporting and Documentation:

• Prepare reports on provider network status, performance, and other key metrics for internal review.
• Maintain comprehensive records of provider interactions, contract negotiations, and network changes.

7. Provider Education and Training:

• Assist in the development and delivery of training programs for providers on company policies, procedures, and systems.
• Create and distribute educational materials to support provider compliance and performance.

Qualifications:

• Bachelor’s degree in business administration.
• Minimum of 2 years of experience in provider network management, healthcare administration, or a related field.

Skills:

• Strong communication and interpersonal skills.
• Excellent organizational and time management abilities.
• Proficiency in data management and reporting tools.
• Knowledge of healthcare regulations and compliance requirements.
• Ability to work collaboratively with internal teams and external providers.

Skills and Competencies:

• High level of accuracy in data management and documentation.
• Ability to analyze data and identify trends.
• Strong problem-solving abilities to address provider issues.
• Commitment to provider satisfaction and service quality.
• Excellent organizational and multitasking abilities.
• Effective written and verbal communication skills.

Working Conditions:

• The Provider Network Specialist may be required to travel to participate in meetings with providers.