Network Management Consultant
Iqocik, Pakistan

Serves as an internal resource and senior member of the department. Serves as technical resource, trainer and mentor to other consultants and contracting staff members. Additionally responsible for providing provider relations and/or network management consulting support to complex, and/or large high profile provider organizations. Primary duties may include, but are not limited to: Responsible for providing guidance to Network Management Consultants regarding resolution of issues that require the intervention of the Provider Engagement and Contracting Department. Provides technical expertise, trains, and mentors other consultants and contracting staff members. Responsible for identifying and facilitating process improvement projects to improve network provider's experience, to reduce provider abrasion and to reduce costs. Serves on inter-departmental committees and project teams as needed to assist with root cause analysis of provider issues, and communicates positive outcomes/solutions to provider issues/concerns. Develops and maintains Policies and Procedures pertaining to the Network Management Consultant team, and provides training to team members as necessary. Acts as department lead when Network Support Manager is absent. Develops and maintains positive relationships with the provider community by conducting routine and issue-based on-site visits, communicating administrative or programmatic changes and facilitating the resolution of provider issues. Researches, analyzes and recommends resolution for contract and reimbursement disputes, non-routine claim issues, billing questions and other practices. Conducts seminars to support the understanding of managed care and BCBS policies and procedures. Assists with network recruitment and retention strategies to ensure the retention and maintenance of high quality contracted providers. Participates in large and/or complex network expansion efforts to recruit new physician specialties or large physician groups. Identifies, researches and analyzes economic and professional provider practice patterns to develop recommendations for improvements. Assists in the strategic implementation of new initiatives for assigned region. Consults with, educates and trains providers on innovative alternative reimbursement programs.

BA/BS and 3-5 years experience in provider network management, utilization management or other health care field or an equivalent combination of education and experience required. Familiarity with Provider Contracts, benefits and claims processing. Prefer some supervisory experience. Strong analytical skills and PC skills required. Good planning and organizing skills required. Strong written, oral and interpersonal communication skills required. Strong ability to negotiate contracts preferred. Strong ability to manage complex business problems. Strong aptitude to continuous quality improvement needs.