This position serves as the main resource of the Provider Network Development and Implementation activities for Adena Care. Reports directly to the Executive Director and assists in executing the strategic direction of and coordinates the day to day provider network development and implementation activities. Coordinates provider credentialing processes pursuant to NCQA guidelines. Under the direction of the Executive Director, this position is responsible for overseeing the processes to implement and maintain signed provider agreements into the database or other systems to record provider demographics, contracted rates, and other information necessary for accurate claims adjudication. Assists with developing member access strategies and monitors network adequacy. This position may also be assigned to negotiate provider contract language and rates under established parameters and protocols.
Required Education, Credentials and Certifications: Associate Degree in Healthcare Administration or related field. Bachelor's degree preferred.
Experience: Minimum 2 years experience in provider network development and/or credentialing with a hospital or health plan. Hospital/physician contracting experience preferred. Other related healthcare business experience.