Network Relations Consultant

** Job Description Summary
** The Network Relations Consult is responsible for assigned network PCP performance including PAHAF completion, AWV and Star rating of 4 or above.
** How will you make an impact & Requirements
**** Network Management Consultant:
** will own individual performance engagement and on-the-ground relationship development for new and existing MDs.
* Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
* Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.
* May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
* Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
* May participation in Joint Operation Committees (JOC) of larger provider groups.
* Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
* Conducts seminars to support the understanding of managed care policies and procedures.
* Identifies network access and deficiencies and develops recruitment and contracting strategies.
* Coordinates and conducts provider training including developing and distributing provider relations materials.
* Responsible for providing quality, accessible and comprehensive service to the company's provider community.
* Provide assistance regarding education, contract questions and non-routine claim issues.
* Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
* Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
* Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
* Tracks and conduct provider refresher training.
* Researches issues that may impact future provider negotiations or jeopardize network retention.
** Requirements:
*** Requires a Bachelor's degree
* Minimum of 3 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
* Travels to worksite and other locations as necessary.
** Quality and AWV*
* • Consistent PCP visits focused on:
• PAHAF completion, STARS gaps closed
• HCC Re-capture rate,
• PCP referrals
** Provider Education*
* • Model of Care
• Portal usage/training Referrals and authorizations
• New PCP on-boarding
** Issue Resolution
** Issue identification & resolution:
• Claims•Referrals and authorizations
• G&A
** The posted compensation range represents the national market average. Compensation for roles located in premium or high-cost geographic markets may fall above this range. This position is bonus eligible based on individual and company performance.  
**** Compensation:**$80,819.00to$At Care More Health, we provide effective Advanced Primary Care and Palliative Care by seeing the whole person — body, mind, and spirit. We do it with doctors and nurses who provide personalized and compassionate care, nationally recognized disease prevention and management programs, and healthy-living plans. It helps patients get healthier, while receiving the healthcare experience they’ve always wanted.

Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi-payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations.

Through Mosaic Health, health plans…