Network Development Rep

Job Description

Network Development Rep.

 Network Development

Austin, Texas

The following job description is a general outline of essential and common functions related to the performance of your job.  All employees of USA Quality Staffing are expected as a condition of employment to perform tasks as assigned by management whether included in your job description or not.

Supervisor

          VP – Network Development

Job Classification

          Administrative

Non-Exempt

Job Summary

Develop and build PPO, Specialty and Medicare networks for a national managed care organization.  Responsible for initiating discussions, giving formal presentations, concluding negotiations, and finalizing Agreements, Amendments, and/or Addenda for network providers and ancillary facilities.  Work with VP of Network Development and appropriate team members to develop and analyze geographic markets.  Work on a strategic negotiation plan to enhance the network provider and ancillary facility availability for both current and potential clients.

Job Responsibilities

·         Act in concert with company and departmental mission statement, objective, strategy and philosophy.

·         Utilize contracting methods within the guidelines established by the department to efficiently build network relationships.

·         Initiate discussions, negotiate rates for services and conclude contracting efforts with facilities.

·         Communicate and coordinate with all members of marketing and contracting team to effectively develop continuum of care and network referral patterns.

·         Re-negotiate reimbursement terms for services.

·         Track and report all progress accurately.

·         Prepare reports to represent marketing productivity, administrative issues, goals and objectives.

·         Adhere to USA Managed Care Organization’s Information Security Policies and Procedures

·         Adhere to HIPAA Guidelines and Requirements

Qualifications

·         Minimum of 1 year experience in negotiating with outpatient facilities and provider reimbursement rates.

·         Familiarity with CPT Coding, Medicare RBRBS and ASC Groupers.

·         Understanding of medical terminology.

·         Excellent communication skills.

·         Excellent organizational skills.

·         Professional appearance.

Physical Requirements

Requires sight and mobility to effectively operate various office machinery including but not limited to computers, telephone, copier, etc.  Must also be able to stand or sit for long periods throughout the day.  Computer/keyboard activity averages over 2/3 of time each day.  Sight requirements include close (clear vision at 20 inches or less), distance (clear vision at 20 feet or more), and ability to adjust the eyes to bring an object into sharp focus.  These requirements result from the demands of reading reports, information and working with computers.  Talking/hearing activity averages over 2.3 of time each day.

Telecommute

            No