IPA, Network Provider Specialist [DALLAS]

Nutex Holdco LLC; Austin (TX); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

401(k) matching

Dental insurance

Flexible spending account

Health insurance

Life insurance

Paid time off

Vision insurance

Job summary

Nutex Holdco LLC in Dallas seeks an IPA Provider Network Specialist to manage the physician network across IPA/Medical Groups. This full-time role requires travel and working under general supervision to build and maintain provider relationships.

You will analyze data, support network improvement plans, coordinate credentialing, and educate offices on policies. Strong communication and negotiation skills are essential, with a track record in network management.

Qualifications

• Bachelor's Degree in Marketing or Business Admin is required.
• Minimum of 2 years experience in Network Management within a managed care environment, health plan, or medical group administration.
• Strong MS Office and data interpretation skills.
• Excellent verbal and written communication; willingness to travel.

Responsibilities

• Completes new provider orientation for applicable product lines.
• Conducts provider group meetings to review monthly/quarterly data and outcomes.
• Follow-up on action items identified at meetings and maintain minutes.
• Perform site visits to service providers to educate staff and collect credentialing data.
• Educate providers on submitting Risk Adjustment Factor Data and HEDIS information.
• Build and maintain relationships with contracted HMOs and implement policy amendments.
• Respond to provider inquiries within 24 hours and resolve issues.
• Provide utilization reports and analytics to support network improvement plans.
• Identify network gaps and contract new PCP, Specialist, and Ancillary providers.
• Develop cost-saving opportunities with committees (UM, Claims).
• Train and mentor new representatives and lead special projects.

Skills

Provider relations

Negotiation

Communication

Data analysis

Education

Bachelor's degree in Marketing or Business Admin

Tools

MS Office

Job description

IPA, Network Provider Specialist [DALLAS]The IPA Provider Network Specialist manages the physician network by developing and maintaining the assigned IPA/Medical Group. This individual provides service and education to network physicians/providers and achieves company targets by implementing network improvement plans. The representative offers professional work and is responsible for performing activities pertaining to IPA Provider Network Specialist. This job includes traveling to provider offices and working under general supervision. Positions at this level are assigned a broad range of duties in the occupation. The representative uses judgment in selecting appropriate guidelines and applying general policies and procedures.JOB TYPE: Full-time; On the RoadRESPONSIBILITIESCompletes new provider orientation for all applicable product lines.Conducts provider group meetings to review monthly/quarterly data and outcomes.Responsible for meeting minutes and follow-up on 'TO DO' items identified at meetings.Conduct site visits to service providers, resolve issues, educate staff and providers on policies, and collect credentialing information.Conduct site visits to service providers and educate staff and providers on submitting Risk Adjustment Factor Data and HEDIS information.Maintains relationships with contracted HMOs to implement amendments to DOFR, delegation, policy, and procedures.Returns all routine calls from providers within 24 hours to establish consistent and robust relationships with provider offices.Provide oversight on inquiries and claims issues and follow up with providers to ensure problems have been resolved.Maintains provider office tools, including provider manual.Supports regional Network Improvement Plan targets by providing utilization reports, ER contingencies, Frequent Flier Reports, and other analytics available to improve /maintain regions.Identifies network gaps and completes contracts for PCP, Specialist, and Ancillary networks with in-depth knowledge of different fee schedules (Medicare/Medical/ASP/AWP).Identifies new cost-saving possibilities through working with various committees, such as UM and Claims.Understands and explains risk contracts (shared risk/entire risk).Strategizes for membership growth and retention.Provide training, mentoring, and guidance to new representatives.Works on special projects as assigned or directed.QUALIFICATIONSKnowledge of MS Office: Word, Excel, PowerPoint, Access Database.Knowledge of MS Provider relations/customer service strategies.Knowledge of MSO-VL and MMSE programs and services: Authorizations, Claims, Credentialing encounters, RAF, Star Ratings, IS/IR, etc.Knowledge of Network development strategies and Provider Relations experience or similar background.Knowledge of current MSO-VL and MMSE geo-access requirements.Effective and efficient oral and written communication skills.Knowledge of County provider demographics.Skills in negotiating contract language and rate structures.Skills to provide training and technical assistance to contracted providers.Skills to evaluate and assess provider network to determine gaps and services needed.Skills to identify and develop new providers to ensure accessibility.Skills to monitor contract performance through site visits and data analysis.Skills to facilitate contracted provider meetings.Ability to represent the department or division professionally.Ability to establish and maintain effective working relationships with contracted and potential providers.Ability to resolve provider inquiries or requests promptly.REQUIREMENTSBachelor's Degree in Marketing or Business AdministrationMinimum of 2 years experience in Network Management within a managed care environment, health plan, or significant medical group administration.BENEFITS:401(k) matchingDental insuranceFlexible spending accountHealth insuranceLife insurancePaid time offVision insurance