Prov Network Contracting Rep

Health Net, Inc. (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies. Health Net’s mission is to help people be healthy, secure and comfortable. The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com  JOB SUMMARY: Develops and maintains an effective working relationship and serves as the liaison between the company and the physician provider network.  Develops and maintains contractual relationships with providers and ensures the development of the network to meet the needs of the assigned geographic territory.  Takes a leadership role in financial analysis, contract development, creation of publications/educational materials, and assigned committees.  Provides educational instruction and support to the providers and their staff thus projecting a positive image and creating good rapport between Health Net and our provider network. ESSENTIAL DUTIES AND RESPONSIBILITIES: Analyze the provider network to ensure the adequacy of the network from cost/utilization and competitor standpoints Recruit providers and provider groups to initiate and develop a contractual relationship determined by financial analysis, and meet projected targets of each potential contract with physicians and physician groups Negotiate contracts with providers and provider groups, within budgeted financial parameters, including the confirmation of correct contract implementation, in order to achieve the goals and objectives of Health Net (HN) Keep detailed and accurate notes regarding all negotiation efforts Provide strategic input on contracting targets and rates for various projects Scan the external local health care market to increase awareness of trends and competition Develop and maintain strong, cost effective and mutually supportive relationships with all providers Identification of provider concerns and evaluates and recommends suitable solutions to HN counterparts and senior management Interface with all internal HN departments to further develop a working relationship with providers Identifies necessary changes and initiates/assists in the development or revision to functioning provider systems with the appropriate departments Facilitate resolution of issues between providers and the appropriate HN departments Liaison in the resolution of provider claim issues, proactively identifies opportunities to improve the provider’s understanding of proper billing and posting procedures Track, resolve and report all medical issues for assigned providers Assist with monitoring the compliance with Quality Management action plans and NCQA standards Serve as the liaison in the research and resolution of member complaints, appeals and grievances Conduct communication sessions with contracted medical group directors, administrators, managed care coordinators and key provider staff to address quality and satisfaction issues Prepare and revise as necessary, training and educational materials Proactive support (servicing) of Plan providers/practitioners including orientation and education of providers and staff and incorporating Plan’s policies and procedures, thus maintaining a positive presence in the provider community Participate in Health Net committees as assigned Communicate relevant changes in medical groups to appropriate Health Net departments Review/ensure accuracy of credentialing status/information for provider directories Develop and manage special projects as assigned Additional duties as assigned 

REQUIREMENTS: Education: Bachelor’s degree or equivalent experienceCertification/License: Experience:Minimum of four years of successful hands on provider services, contract analysis, and negotiating experience in the managed care industry or 5+ years varied and responsible experience in health care or any combination of education/experience that provides an equivalent backgroundKnowledge, Skills & Abilities:Strong analytical, communication, written skills, organizational & interpersonal skills Must be willing to travel 2-3 days per week in field and be capable of transporting self to various work locations; if operating a motor vehicle, must have a current, valid Arizona driver’s license and proof of insurance coverage that meets or exceeds the current state minimum requirements (must be maintained as a condition of employment). Some overnight travel may be required. OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position. Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening. Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.