Provider Network Specialist

Socket.dev; Linthicum (MD); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care’s statewide provider network of hospitals and physicians.

The role focuses on evaluating contracts, applying reimbursement principles, and coordinating with departments to implement efficient and compliant agreements. The position involves leading a team of Provider Data Coordinators, ensuring regulatory reviews, and maintaining network coverage through Geo Access reporting and analysis.

Qualifications

• Ability to review and comprehend contracts and services.
• Ability to present information effectively to providers and employees.
• Strong problem-solving, data analysis, and action planning abilities.
• Excellent organizational and coordination skills.
• Experience with Geo Access or similar systems is required.

Responsibilities

• Evaluates current contracts, and applies managed care reimbursement principles to identify cost savings while maintaining quality.
• Researches contract procedures and coordinates with departments to streamline processes.
• Coordinates implementation of new contracts with involved departments.
• Coordinates internal review and determine/evaluate administrative feasibility throughout contracting process.
• Initiates contract flow process; ensures signatures and data entry are completed.
• Acts as team lead and trainer for Provider Data Coordinators.
• Ensures legal/regulatory review of contracts prior to execution.
• Monitors provider availability and accessibility to ensure network coverage.
• Creates and reviews Geo Access reports and makes recommendations for future network build-out.
• Assists with onsite contractual reviews; ensures data accuracy in provider files.

Skills

Contract review

Contract negotiation

Data analysis

Geographic analysis

Presentation skills

Microsoft Office

Education

Bachelor’s degree in business/health/management systems

Tools

Microsoft Office Suite

Job description

Summary:

Assesses network access and generates reports, including Geo Access, for provider network analysis and planning. Identifies recruitment opportunities and assists in the analysis and development of cost-effective, contractual agreements with healthcare providers and institutions that can be administered efficiently and that follow state and federal regulatory requirements.

About Maryland Care Management, Inc. (MCMI)

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.

Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.

What You’ll Do:

• Evaluates current contracts, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to identify cost savings, while maintaining quality.
• Researches current and new contract operational procedures; coordinates with appropriate departments, to streamline processes wherever possible.
• Coordinates implementation of new contracts with departments involved.
• Coordinates internal review and determine/evaluate administrative feasibility throughout the continuum of the contracting process.
• Initiates contract flow process; ensures appropriate signatures, and data entry to system.
• Acts as team lead and trainer for Provider Data Coordinators.
• Ensures appropriate legal / regulatory review of contracts prior to execution.
• Monitors provider availability and accessibility to ensure provider network coverage.
• Creates and reviews Geo Access reports and makes recommendations for future provider network build-out.
• Assists with onsite contractual reviews; ensures 100% accuracy and timeliness of information/modification data entry in provider files of Geo Access system.
• Assists with training of providers regarding MPC processes and benefits; conducts follow-up training to ensure policy compliance and education continuity; disseminates written correspondence as necessary to address issues, problems, and new information, as needed.

Requirements

Knowledge and Skills:

• The ability to review and comprehend contracts and services.
• The ability to present information effectively in one-on-one and small group settings to providers and employees.
• The ability to use advanced reason to define problems, collect data, establish fact, draw valid conclusions, and design, implement, and manage appropriate action plans.
• Advanced and meticulous organization and coordination.
• Must be able to successfully utilize geographic accessibility data, and Microsoft Office Suite and common computer and office hardware.

Education and Work Experience:

• Bachelor’s degree in business, health, management systems or closely related field is preferred, although an equivalent combination of formal education and experience may substitute for a degree.
• Experience with large provider organizations, ancillary and hospital providers, clinical terminology.
• Working experience with Geo Access or equivalent system is required.

EEOC Statement:

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment.

As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive.

We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.