Provider Network Development Analyst

Sioux Center Health; Sioux Falls (SD); On-site; USD 58,240 - 87,360; Full time

Benefits offered by this job

PTO from day 1

Employer retirement match up to 5%

Career development

Job summary

The position of Provider Network Development Analyst at Avera Health Plans is based in Sioux Falls, SD. You will build and manage network expansion and contracting strategies, analyze provider data, and work across Sales, Product and Business Development to drive growth and ensure network adequacy.

You will maintain KPI dashboards, support regulatory compliance, and mentor staff while collaborating with cross-functional teams to secure participation and favorable agreements with providers.

Qualifications

• Bachelor's degree and at least five years in the health care industry.
• Experience with provider networks, contracting and credentialing preferred.
• Ability to analyze provider data and regulatory requirements.

Responsibilities

• Develop and implement network expansion and maintenance strategies.
• Analyze provider networks and contracts across geographies.
• Prepare network adequacy reports and dashboards.
• Support Sales, Product and Business Development with ad-hoc analysis.
• Collaborate with VP and cross-functional teams to drive contracting and growth.
• Maintain provider data accuracy and governance.

Skills

Network expansion strategies

Contract analysis

Provider relations

Data analytics

Education

Bachelor's degree

Job description

Location: Avera Health Broadband Lane

Worker Type: Regular

Work Shift: Day Shift (United States of America)

Pay Range: $58,240.00 - $87,360.00

The pay range for this position is listed below. Actual pay rate dependent upon experience.

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Provider Network Development Analyst is responsible for maintaining a current and comprehensive knowledge of geographic market differences which may influence how providers are contracted. The position serves as the primary source of network recruitment planning to drive understanding of the Avera Health Plans Network capabilities and benefits with the objective to secure participation and signed agreements with providers. The Provider Network Development Analyst will assist in the development of network expansion activities and contracting target lists. Comprehension of provider data, service areas and adequacy requirements, regulatory compliance with a deep understanding on the impact to sales activities, network gaps, along with exceptional communication are imperative for success. Acts as subject matter expert (SME), serves as a resource and mentor for other staff. Maintaining network KPI reports and performance dashboards. The Provider Network Development Analyst will use of analytics, competitor benchmarking, and network adequacy criteria to continually identify network expansion and implement plans to achieve business goals.

What you will do

• In partnership with your leader, development and implement, network expansion and maintenance strategies, and performance improvement strategies to ensure Avera Health Plans meets its financial performance targets.
• Support analysis of supplier contracts in the assigned geographic area and maintain comprehensive understanding of a variety of provider networks (including narrow networks, self-funded networks, employer specific networks and comprehensive or PPO networks).
• Assist with the development, implementation of broad based, tiered and narrow network products and value-based contract arrangements and plays a critical role in increasing brand awareness with providers by identifying, researching, vetting and developing an assessment of the provider and business landscape.
• Produce annual network adequacy reports, templates and Health Service Delivery (HSD) tables to support successful product filings and development. Lend support and network expertise to Business Development, Product and Sales teams in ad-hoc network analysis reporting including access and disruption reports for employer groups and RFP work. Deliver dashboard reporting to demonstrate network adequacy, expansion and performance reporting to leadership that communicates to local market teams applicable updates regarding contracting efforts and results.
• Track network adequacy across all service areas and Assist the Vice President of Network Development, Provider Relations and Contracting in partnering with the Sales, Account Management, Population Health and Product teams to identify supplemental network providers and ideas for network development/contracting efforts to produce networks that enhance sales activities and promote growth of Avera Health Plans.
• Promote activities to achieve the overall strategy and objectives of the Network Services department, promoting Avera Health Plans integration conversations with existing and potential provider groups.
• Responsible for accurate provider database management and regular updates to the provider data source of truth that supports network adequacy, disruption and access reporting.
• Identify and research resources for developing specialist, primary care and behavioral health leads for new business areas and gaps in a comprehensive provider network and limited networks as designed by product offerings.
• Conduct initial outreach and telephone communication which identify provider interest and qualifies them for contracting activities. Analyze complex variables and recommend most appropriate contracting process.
• Execute on special projects as assigned.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Bachelor's
• Minimum of five years experience in the health care industry

Preferred Education, License/Certification, or Work Experience:

• Minimum of three years of applicable experience with health insurance with focus on provider relations, contracting and credentialing.

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].