Job Description

Let\'s do great things, together

Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we\'re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Working in a matrix environment, the Network Development Representative II will be responsible for entering into new contractual relationships with providers, maintaining those relationships and acting as a liaison between the contracted provider and Moda Health. Specific functions include: provider outreach and relationship building, preparing, reviewing and revising contracts, using analytical tools and strong communication skills in negotiating challenging contract renewals, and cultivating and maintaining professional relationships with providers and practices. The Network Development Representative II is also responsible for presenting, promoting and resolving concerns and issues brought forward by the providers or the Health Plan.


\xe2\x80\x8b\xe2\x80\x8b\xe2\x80\x8b\xe2\x80\x8bThis is a Hybrid position located in Alaska.
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Please follow the link below to apply to this position:
\xe2\x80\x8b\xe2\x80\x8bBenefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

• Bachelor\'s degree in Business, Finance, Health Care Administration or 2 years\' equivalent work experience in a related field.
• Minimum 3+ years\' experience negotiating contracts, specifically with ancillaries, facilities, specialty providers, and physician groups.
• Position requires a highly self-motivated person who is able to apply judgment in the prioritization of assignments, is organized and efficient in their approach to the work and is able to work both independently and as a team member in achieving objectives.
• Proactive personality who will anticipate future needs and problems, develop strategies, and complete tasks before required by a supervisor.
• Demonstrated strong interpersonal communication skills, including strong business writing skills in a manner that promotes goodwill, is timely, efficient and accurate.
• Possess strong analytical, attention to detail, and problem-solving skills.
• Understanding of physician, hospital, and other provider contracts and reimbursement mechanisms.
• Ability to work with internal stakeholder departments to create a seamless and positive experience for the provider.
• Strong judgment and decision-making skills with ability to develop and foster strong working relationships.
• Strong PC proficiency with Microsoft Office applications.
• Ability to work well under pressure as well as with frequent interruptions and shifting priorities. Ability to function effectively in a complex, ambiguous, demanding, and rapidly changing environment.

Primary Functions:

• Reporting directly to Alaska Regional Sales Manager with a dotted line relationship to Provider Relations, develops strategic relationships with key providers and negotiates annual rate increases within set parameters and guidelines.
• Assists in the periodic assessment of Moda\'s network status and recommends strategies when new trends are identified. Provides insight into strategy development based on network analysis results.
• Requires significant autonomy to establishing new relationships and resolve issues with providers and Hospital CFOs, CEOs, and Executives. This position will be the key Med PR representative representing Moda\'s perspective in Alaska.
• Assists in the new implementation and ongoing modification of Moda\'s statewide, regional, and local network strategies.
• Handles moderately complex new contracts and contract renewals using problem solving skills to meet budget constraints. Develops rapport with provider groups and/or hospitals and works with the Provider Analytics and Contract Pricing teams to apply complex rate methodologies within assigned portfolio.
• Requires expertise in industry practices, specialized payment methodologies, VBC agreements, Payer/Provider Strategic Partnerships, new relevant regulations.
• In collaboration with Provider Network Manager, develop a contracting approach and develop specialized expertise required to contract with new types of provider entities. This can occur when entering into a new ongoing contractual relationship or when negotiating Single Case Agreements.
• Identify root cause of claim problems and trends and participate in developing solutions. This includes performing research through available systems, policies and departments ensuring timely resolution is achieved.
• Develop and review Dashboard metrics (quality, financial, triple AIM) and translate into
• actionable items based on group specifics.
• Work in a consultative role with various departments creating effective information and analyses in order to optimize the market\'s strategic objectives for providers.
• Utilize best practice policies and procedures, work guides or tools to provide improved department process workflows.
• Coordinate and participate in targeted provider meetings, including annual Provider Workshops, with Provider Relations Representatives in assigned portfolio.
• Represents Moda at meetings and events at which contracted Moda hospitals and key Moda providers will be attending.
• Conduct regular on-site provider visits to create visibility in Alaska and to foster relationships with ancillary, primary care, specialists, multispecialty providers, rental networks, vendors and complex health systems with significant spend, clinically integrated networks.
• Educate providers on their health plan contract language ensuring consistent interpretation.
• Provide timely responses to all provider inquiries, within in two business days.
• Provides ongoing support to team members.
• Performs other duties as assigned.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.

Moda Health