Provider Network Specialist jobs in Pittsburgh, PA

Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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VP Reimbursement, Provider & Network Programs
  • Highmark Health
  • Pittsburgh, PA FULL_TIME
  • Company :

    Highmark Health

    Job Description : 

    JOB SUMMARY

    This role is accountable for any program or strategic tactic to drive provider performance in the domains of reimbursement and network programs. Specifically, the incumbent will lead the strategy and creation of value-based reimbursement (VBR) & risk programs, as well as the overall provider inventive and payment strategy. The role also leads the strategy and creation of provider network designs and programs.

    The incumbent is responsible for understanding regulatory trends and competitive advantages / disadvantages when formulating strategies. Accountable in any program design for the full business case including implementation strategy and working with rest of organization to ensure resources, technology, communications, training are in place. Programs should be ready to operationalize once transitioned. The incumbent will develop market rollout plans and roadmaps for the programs and will tie in enterprise and provider strategy into the creation of these programs.


    ESSENTIAL RESPONSIBILITIES

    • Responsible for the strategy and creation of provider reimbursement programs to position the organization competitively based on market trends and forecasting.
    • Lead the team that builds, updates, and maintains and the multi-year roadmap for reimbursement program evolution. This includes custom VBR programs established with strategic provider partners, joint economic models, and standard models such as True Performance and Quality Blue.
    • Responsible for creating on a holistic incentive and payment strategy, including RPM, STARS, and Quality programs. Gain approval from internal stakeholders, and communicate the support and requirements needed across the enterprise to operationalize.
    • Develop and maintain HPN network design strategy, translating product / segment needs to provider and market executives.
    • Oversee development of tools and analytics needed for identification, inclusion, and management of network participants. Oversee design and development of Network performance scorecards.
    • Responsible for ensuring alignment strategy and tactical playbook drives volume to preferred networks in each market, and responsible for working with market executive function to set steerage goals.
    • Oversee strategy for disruption and mitigation planning.
    • Perform management responsibilities to include but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
    • Other duties as assigned or requested.

    EXPERIENCE

    Required

    • 10 years of relevant experience in large, complex, highly matrixed organization
    • 7 years leadership experience
    • 7 years in Healthcare Strategy, with strong preference for Payor experience
    • Extensive knowledge of new and emerging trends in reimbursement, network and payment model design or management.
    • Understanding of regulatory trends in reimbursement (CMS, Price Transparency etc.)
    • Excellent written and oral communication skills with the ability to present complex information clearly and persuasively.


    Preferred

    • None

    EDUCATION

    Required

    • Bachelor’s degree in business, Healthcare administration or a related field required.

    Substitutions

    • None


    Preferred

    • Master's Degree.


    LICENSES or CERTIFICATIONS

    Required

    • None


    Preferred

    • None


    Language (Other than English):

    None

    Travel Requirement:

    0% - 25%

    PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

    Position Type

    Office- or Remote-based

    Teaches / trains others

    Occasionally

    Travel from the office to various work sites or from site-to-site

    Rarely

    Works primarily out-of-the office selling products/services (sales employees)

    Never

    Physical work site required

    No

    Lifting: up to 10 pounds

    Constantly

    Lifting: 10 to 25 pounds

    Occasionally

    Lifting: 25 to 50 pounds

    Rarely

    Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

    Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


    As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

    Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

    EEO is The Law

    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

    We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

    For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

    California Consumer Privacy Act Employees, Contractors, and Applicants Notice


  • 1 Month Ago

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Advanced Practice Provider, Endocrine
  • Allegheny Health Network
  • Wexford, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: The Advanced Practice Providers at Allegheny Health Network are an integral part of the care delivery system working together to ...
  • 1 Month Ago

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Advanced Practice Provider, Movement Disorder
  • Allegheny Health Network
  • Pittsburgh, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: The Advanced Practice Providers at Allegheny Health Network are an integral part of the care delivery system working together to ...
  • 21 Days Ago

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Advanced Practice Provider Specialty, Hospitalist
  • Allegheny Health Network
  • Monroeville, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job is an integral part of the care delivery system working together to provide a healing environment, by placing our custom...
  • 5 Days Ago

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Advanced Practice Provider Specialty, Hospitalist
  • Allegheny Health Network
  • Pittsburgh, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job is an integral part of the care delivery system working together to provide a healing environment, by placing our custom...
  • 9 Days Ago

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Advanced Practice Provider Specialty, Oncology
  • Allegheny Health Network
  • Pittsburgh, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job is an integral part of the care delivery system working together to provide a healing environment, by placing our custom...
  • 10 Days Ago

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0 Provider Network Specialist jobs found in Pittsburgh, PA area

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Network Engineer
  • Franklin Fitch
  • Pittsburgh, PA
  • Network Engineer | Hybrid Pittsburgh PA | $95,000 - $115,000 🌐 Do you enjoy optimizing & maintaining network infrastruc...
  • 3/29/2024 12:00:00 AM

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Field Service Engineer
  • Johnson Service Group
  • Pittsburgh, PA
  • Job Description Job Description Field Service Field Engineers (FSE) provide troubleshooting, repair services and schedul...
  • 3/29/2024 12:00:00 AM

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Interface Developer II (SW Engineer II) - Remote
  • Net Health
  • Pittsburgh, PA
  • About Net Health Belong. Thrive. Make a Difference. Are you looking for a meaningful and satisfying career where you hav...
  • 3/29/2024 12:00:00 AM

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Senior Network Engineer
  • Emerson Group
  • Pittsburgh, PA
  • Job Description Power & Water Solutions is an industry-leading controls automation company that provides applications in...
  • 3/28/2024 12:00:00 AM

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Systems Administrator - DevOps
  • eProductivity Software
  • Pittsburgh, PA
  • eProductivity Software (ePS), headquartered in Pittsburgh, PA, is a leading global provider of industry-specific busines...
  • 3/28/2024 12:00:00 AM

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Senior Network Engineer
  • Emerson
  • Pittsburgh, PA
  • JOB DESCRIPTION Power & Water Solutions is an industry-leading controls automation company that provides applications in...
  • 3/26/2024 12:00:00 AM

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Network Engineer
  • Alpine Solutions Group
  • Pittsburgh, PA
  • We are seeking a Network Engineer to join our legal client’s team in Pittsburgh, PA. This is a full time position and wi...
  • 3/25/2024 12:00:00 AM

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Network Analyst
  • Robert Half
  • Pittsburgh, PA
  • Robert Half is looking for Network Engineers who are deeply passionate about networking hardware and software. Are you a...
  • 3/25/2024 12:00:00 AM

Pittsburgh (/ˈpɪtsbɜːrɡ/ PITS-burg) is a city in the Commonwealth of Pennsylvania in the United States, and is the county seat of Allegheny County. As of 2018, a population of 308,144 lives within the city limits, making it the 63rd-largest city in the U.S. The metropolitan population of 2,362,453, is the largest in both the Ohio Valley and Appalachia, the second-largest in Pennsylvania (behind Philadelphia), and the 26th-largest in the U.S. Pittsburgh is located in the south west of the state, at the confluence of the Allegheny, Monongahela, and Ohio rivers. Pittsburgh is known both as "the ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$57,936 to $86,641
Pittsburgh, Pennsylvania area prices
were up 1.9% from a year ago

Provider Network Specialist in Springfield, MO
As the liaison between provider and the health plan, candidates are tasked with ensuring improved revenue generated and patient quality score.
December 16, 2019
Provider Network Specialist in Stamford, CT
Previous experience in a network development, provider recruitment or provider contracting.
December 04, 2019
Provider Network Specialist in Fort Wayne, IN
In this position, employees will be expected to perform benefits analysis and create reports on provider performance to support the needs of the analysis found.
January 18, 2020