MCS Puerto Rico
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Network Management Specialist
role at
MCS Puerto Rico
3 weeks ago Be among the first 25 applicants
General Description Execute provider interventions to discuss performance metrics, monitor progress, and coordinate strategic events and interactions among physicians. Analyze the market data and adequacy, follow the legal requirements by type of service, and ensure that the contracting process is in line with policy and regulatory standards. Responsible for coordinating visits and negotiating economic agreements for the distinct types of providers and the company's business lines.
Regular
Exempt
Essential Functions
Promotes educational content related to network initiatives in alignment with other operational areas and serves as a liaison between the provider and other operational areas to support the resolution of service and contracting situations.
Promotes value based care through the discussion on Value Care, Quality, Access and Availability, through interventions with providers.
Provides feedback regarding market updates, initiatives, and trends.
Receives, documents, responds to, and forwards requests for contracting, renewing, changing, or amending agreements from providers in any region of Puerto Rico.
Provides service support, assisting the providers, removing barriers, resolving issues or concerns raised promptly, ensuring their effective resolution.
Administers contracting activities and negotiations, as established by its supervisor. Provides education on best practices, makes educational interventions with providers to discuss key business elements such as: contracting responsibilities, education, encounters reporting, performance metrics, economic agreements of all medical services, among other business priorities.
Refers any changes in provider demographic information to the corresponding team.
Responsible for coordinating all the special activities for physicians.
Develops and maintains an effective business relationship with the Provider, ensuring that they understand policies and procedures, compliance requirements, the contract's structure, specifications, and/or details, the history, and alternative resolution situations and/or agreements. Maintain a cordial and professional relationship with the provider and the provider team. Canalize any situation of a service report by the provider or the provider team.
Maintains continuity in registering internal and external assigned requests and provides the necessary follow-up to respond to these requests within the established time.
Document all interventions and manage any pending issues in a reasonable time frame. Maintain the provider in all instances informed about the progress and resolution (end-to-end process).
Visit facilities and conduct audits to ensure compliance with company policies, procedures, and State and Federal laws concerning contracted services and renewal.
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
Minimum Qualifications Education and Experience:
Bachelor's Degree in Public Health, Health Administration, or related fields. At least three (3) years of experience visiting physicians and negotiating agreements for contracting facilities and/or provider services, preferably in the Healthcare Industry.
“Proven experience may be replaced by previously established requirements.”
Certifications / Licenses:
A valid driver's license in the Commonwealth of Puerto Rico is required.
Other:
Car in good condition and available to travel to different locations in Puerto Rico.
Languages:
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento”
Seniority level Mid-Senior level
Employment type Full-time
Job function Information Technology
Industries Insurance
#J-18808-Ljbffr
Network Management Specialist
role at
MCS Puerto Rico
3 weeks ago Be among the first 25 applicants
General Description Execute provider interventions to discuss performance metrics, monitor progress, and coordinate strategic events and interactions among physicians. Analyze the market data and adequacy, follow the legal requirements by type of service, and ensure that the contracting process is in line with policy and regulatory standards. Responsible for coordinating visits and negotiating economic agreements for the distinct types of providers and the company's business lines.
Regular
Exempt
Essential Functions
Promotes educational content related to network initiatives in alignment with other operational areas and serves as a liaison between the provider and other operational areas to support the resolution of service and contracting situations.
Promotes value based care through the discussion on Value Care, Quality, Access and Availability, through interventions with providers.
Provides feedback regarding market updates, initiatives, and trends.
Receives, documents, responds to, and forwards requests for contracting, renewing, changing, or amending agreements from providers in any region of Puerto Rico.
Provides service support, assisting the providers, removing barriers, resolving issues or concerns raised promptly, ensuring their effective resolution.
Administers contracting activities and negotiations, as established by its supervisor. Provides education on best practices, makes educational interventions with providers to discuss key business elements such as: contracting responsibilities, education, encounters reporting, performance metrics, economic agreements of all medical services, among other business priorities.
Refers any changes in provider demographic information to the corresponding team.
Responsible for coordinating all the special activities for physicians.
Develops and maintains an effective business relationship with the Provider, ensuring that they understand policies and procedures, compliance requirements, the contract's structure, specifications, and/or details, the history, and alternative resolution situations and/or agreements. Maintain a cordial and professional relationship with the provider and the provider team. Canalize any situation of a service report by the provider or the provider team.
Maintains continuity in registering internal and external assigned requests and provides the necessary follow-up to respond to these requests within the established time.
Document all interventions and manage any pending issues in a reasonable time frame. Maintain the provider in all instances informed about the progress and resolution (end-to-end process).
Visit facilities and conduct audits to ensure compliance with company policies, procedures, and State and Federal laws concerning contracted services and renewal.
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
Minimum Qualifications Education and Experience:
Bachelor's Degree in Public Health, Health Administration, or related fields. At least three (3) years of experience visiting physicians and negotiating agreements for contracting facilities and/or provider services, preferably in the Healthcare Industry.
“Proven experience may be replaced by previously established requirements.”
Certifications / Licenses:
A valid driver's license in the Commonwealth of Puerto Rico is required.
Other:
Car in good condition and available to travel to different locations in Puerto Rico.
Languages:
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento”
Seniority level Mid-Senior level
Employment type Full-time
Job function Information Technology
Industries Insurance
#J-18808-Ljbffr