Network Development Specialist III

What are important things that YOU need to know about this role?

• Remote Work: This is a permanently remote position.
• Work Hours: Full-time, Monday through Friday during daytime hours.
• Experience Requirements: Comfort with phone outreach is essential. Experience in sales or negotiation is a plus and can contribute to success in this role.

What will YOU be doing for us? Act as a subject matter expert for resolving complex provider contracting issues and escalations. Provide education to providers about processes and procedures as they enter the network as well as resolutions to common issues and questions. Delivers training specific to the Network Development job function as well as managing the Network Development Knowledge base.

What will YOU be working on every day?

• Serve as subject matter expert relative to geographic access reporting to ensure department is targeting appropriate areas of need
• Provide support to team for department reporting
• Develop and maintain training materials and job aids
• Deliver new hire and ongoing Network Development training within the department
• Act as a mentor to junior team members and provide feedback as necessary
• Represent the department on organizational projects and system enhancements
• Serve as single point of contact relative to general/non-market specific inquiries
• Perform market analysis on new markets including identifying key providers needed to service members
• Develop and maintain complete understanding of contract and network requirements
• Identifies opportunities for cost savings and process improvements related to the contracting process
• Perform analysis on providers that may be outside targeted reimbursement schedule or performance standards and develop strategies for cost reductions and increasing quality.
• Provide support to team as subject matter expert relative to navigating proprietary software applications
• Perform prospecting calls to new and existing providers to discuss the benefits of joining our networks and providing education about our practices and reimbursement levels.
• Conduct negotiations with complex and major provider contracts as needed to support network adequacy
• Conduct negotiations with key providers including large groups, hospitals, and dental schools within networks.
• Manage contract activities with national corporate provider chains
• Create and maintain standardized campaign materials
• Manage networks for key clients or markets
• Lead contracting efforts on new multi-recruiter network build campaigns
• Develop and maintain provider relationships by interacting directly with the provider and serving as the main point of contact for the provider throughout the contracting process
• Ensure provider compliance with contracting process
• Leverage relationships with existing providers to generate referrals to additional providers in the network.
• Identify network access and deficiencies and develops recruitment and contracting strategies.
• Perform outreach calls in order to resolve specific access to care issues for members.
• Maintain understanding of the web portal in order to effectively explain its functionality to providers.

What qualifications do YOU need to have to be GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates
  • Bachelor’s Degree in business or related field or equivalent years of experience
• Required Level of Experience
  • Minimum of 5 - 7 years of experience related to contracting, network development, or network management
• Required Knowledge, Skills, and Abilities
  • Intermediate knowledge of Microsoft Office products including Word, Excel, and Outlook
  • Subject matter expert relative to geographic access and other reporting
  • Excellent communication written and verbal communication skills
  • Ability to communicate effectively with a variety of communication styles
  • Strong analytical skills
  • Ability to lead projects and people
  • Inquisitiveness and ability to manage situations and information that lacks clear definition.

What qualifications do YOU need to have to be a GREAT candidate?

• Preferred Level of Education, License, and/or Certificates
  • Bachelor’s Degree
• Preferred Level of Experience
  • 5-7 years in a Network Development role
  • 1-3 years in training, development and quality assurance
• Preferred Knowledge, Skills, and Abilities
  • Knowledge of standard dental, medical and/or therapy terminology
  • Knowledge of internal software

SKYGEN is the trusted partner for specialty benefits payers and government agencies responsible for the delivery and administration of dental and vision benefits. Through cutting-edge technology and service solutions, SKYGEN empowers clients to become the most efficient, effective healthcare organizations in the country.