Network Operations Representative

Job Title

Summary Position is responsible for establishing, building, and maintaining relationships with the participating physicians of the Houston based Unity Health Partners Healthcare Collaborative and their office staff. The position assists in contract negotiations, contract management and optimizing a high-performing network of both PCP and Specialty physicians. The role develops and preserves strong relationships with physicians, office managers and supporting personnel with an eye toward optimizing value-based incentive relationships.

Location Houston, TX Essential Functions include the following. Other duties may be assigned.

• Provide operational and managerial support to HCC physicians, including but not limited to : Provider Contracting (professional, ancillary and vendor) Shared Savings Quality Incentive Programs Partial and Full Risk-Based Initiatives Provider Information and Credentialing; Provider Relations, Account Management & Education; Data Exchange and Integrity; Reimbursement and Data Analysis; and, Communications and Relationship Management
• Create and deliver materials to educate physicians and their office personnel with regards to contracts, policies and procedures, quality and service line initiatives, and financial performance.
• Serve as the primary liaison for physicians and their practices participating with the HCC in value-based care initiatives.
• Establish and maintain a supportive, collegial role with HCC physicians and their practices.
• Proactively identify interventions that will facilitate success in practices.
• Take appropriate actions to increase revenue, leverage resources, manages and / or minimizes expenses, drive medical expense initiatives and ensure compliance with all regulatory requirements.
• Understand, develop, track, monitor and report on key program performance metrics, such as utilization, coding, and STARs / quality performance.
• Facilitate resolution related to practice concerns, grievances, claims and care delivery.
• Assist in the STARS and clinical metrics data collection, and design plans for enhanced provider engagement in quality initiatives.
• Prepare materials and participate in monthly operational meetings with senior leadership.
• Partner with other internal departments, including but not limited to Health Services, Medical Economics, Sales, and Quality / Coding in order to develop solutions for strategic business needs.
• Support network related activities associated with any expansion initiatives in new markets.

Education

Experience

Skills

Technical Skills