Network Provider Relations & Provider Data Specialist (Medical)

TL;DR

Network Provider Relations & Provider Data Specialist (Medical): Managing a geographic medical network for a health plan with an accent on contract negotiation and provider data management. Focus on ensuring network adequacy, analyzing fee schedules, and maintaining regulatory compliance.

Location: Must be based in the United States and reside in the US Central (CST) or US Eastern (EST) time zones.

Company

hirify.global, a Globe Life company, is a major medical division focused on integrating high-technology into health insurance to increase access and transparency.

What you will do

• Develop and manage a provider network in assigned geographic areas, specifically the Texas metroplex.
• Negotiate and amend commercial contracts with physicians, provider groups, and hospital systems using various payment methodologies.
• Collect and standardize roster updates, ensuring data accuracy within Salesforce.
• Monitor network adequacy and quality to comply with regulatory time, distance, and choice requirements.
• Analyze provider and hospital fee schedules in collaboration with analytics and actuarial teams to benchmark against goals.
• Resolve provider complaints regarding claims, service issues, and general network concerns.

Requirements

• Must reside in the United States within the CST or EST time zones.
• 5+ years of experience negotiating provider contracts, including physician/provider groups and value-based/risk parameters.
• Established relationships and experience within the Texas provider community.
• Proficiency in MS Excel for handling large data files and Salesforce for contract tracking.
• Analytical experience with SERFF reporting for network adequacy.
• Required to have a dedicated, private work area with high-speed internet.

Culture & Benefits

• Comprehensive health, dental, and vision insurance.
• Retirement savings plan with company 401(k) matching.
• Flexible, fully remote work environment.
• Professional development opportunities.
• Paid vacation, life, and disability insurance.