Top Provider Network Executive jobs in New Mexico

Top Provider Network Executive plans and directs all aspects of an organization's provider network function. Responsible for developing the network and negotiating and administering contracts. Being a Top Provider Network Executive oversees provider relations and monitors and directs all provider services. Requires a bachelor's degree. Additionally, Top Provider Network Executive typically reports to a top management. The Top Provider Network Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Provider Network Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)

U
PROVIDER NETWORK SPECIALIST
  • UNM Hospitals
  • Albuquerque, NM FULL_TIME
  • Department: Provider Network Development


    FTE: 1.00
    Full Time
    Shift: Days


    Position Summary:
    Manage negotiation, operation, and administration of liaison activities associated with healthcare provider contracting for the TriWest Veteran Administration (VA) Community Care Network (CCN) for the state of New Mexico. Develop and deliver provider education for participant facilities and individual physicians, in compliance with CCN program requirements, and conduct research into claims, referral and authorization, and other operational issues related to provider contracting and networking. Ensure adherence to Hospitals and departmental policies and procedures. No patient care assignment.


    Detailed responsibilities:
    • NETWORK RELATIONS - Manage the negotiation of individual network contracts with hospitals, physician groups, and other health care related agencies and companies in New Mexico and West Texas
    • NETWORK RELATIONS - Manage negotiation of various contract rates and reimbursement methodologies for all network agreements, ensuring compliance with the VA, TriWest, Medicare, or industry regulations, as appropriate
    • NETWORK RELATIONS - Oversee the negotiation and establishment of contract language and legal requirements in compliance with VA and Triwest requirements, University policies, industry standards and other Federal laws and regulations
    • NETWORK RELATIONS - Serve as primary interface and liaison with TriWest CCN network administration, management, and staff, as needed to execute contracts, resolve contractual problems and issues, and provide information and instruction
    • NETWORK RELATIONS - Plan, develop, and deliver education programs for network entities on all aspects of CCN requirements, to include program administrative guidelines, operational processes, billing, credentialing and certification, and related issues
    • RESOURCE - Serves as primary operational liaison with the TriWest Corporation; independently oversee key operational activities between NM Providers and Triwest, to include referral and authorization operations, claims adjudication, educational activities, and planning for network providers to meet VA staffing requirements
    • PROCESS IMPROVEMENT- Research and assess CCN network needs and develop strategies to meet network operational requirements and goals; analyze issues such as provider and coverage needs and data access standards in support of contracting and network development strategies
    • ISSUE RESOLUTION - Provide oversight and primary liaison services between CCN network providers and the identified claims payment administrator for the program; identify claims payment issues and/or trends and coordinate resolution of problems and issues with the payer
    • ISSUE RESOLUTION - Represent network entities in individual discussions with the claims payment administrator and TriWest; analyze Explanation of Benefits documents received from the administrator and/or Medicare, and resolve individual payment problems and issues, as they arise
    • OTHER - Perform miscellaneous job-related duties as assigned
    • COMMUNICATIONS – Maintain and update all provider and institutional contract and credentialing application documents; create and share spreadsheets for tracking current contracting statuses; plan, develop, implement and update the UNMH CCN internet web page, including links for provider resources
    • DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops


    Qualifications


    Education:
    Essential:
    • Bachelor's Degree
    Education specialization:
    Essential:
    • Related Discipline


    Experience:
    Essential:
    3 years directly related experience

    Nonessential:
    No preferred experience


    Credentials:
    Essential:
    • Not Applicable/Not Required


    Physical Conditions:
    Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.


    Working conditions:
    Essential:
    • No or min hazard, physical risk, office environment
  • 3 Days Ago

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Provider Network Representative
  • Innovative System Group
  • Albuquerque, NM CONTRACTOR
  • DUTIES & RESPONSIBILITIES: Provide information and assistance needed to resolve problems experienced by practitioners in their various contractual relationships with the company, including but are not...
  • 1 Month Ago

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Supervisor Network Development-Provider Contracting
  • Presbyterian Healthcare Services
  • Albuquerque, NM FULL_TIME
  • Overview Supervises team responsible for conducting provider contracting functions including reimbursement negotiations, as necessary, to achieve cost targets and support network strategies. Supervise...
  • 21 Days Ago

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Manager Network Development-Provider Contracting
  • Presbyterian Healthcare Services
  • Albuquerque, NM FULL_TIME
  • Overview This opportunity is open to remote applicants in the United States, with the exception of the following states: Washington, Wyoming, North Dakota, and Ohio. Must be able to work mountain time...
  • 22 Days Ago

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Family Medicine Physician
  • Provider Solutions & Development
  • Hobbs, NM FULL_TIME
  • Covenant Health is seeking a full-time Family Medicine physician to join the Covenant Lea Regional Medical Center in Hobbs, New Mexico. This is a brand-new hospital that opened in October of 2022 wher...
  • 2 Days Ago

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Provider
  • Comfort Keepers- Las Cruces, NM
  • Las Cruces, NM FULL_TIME
  • Job descriptionProviders needed all days and shifts.Apply atCK561.ERSP.biz/employmentComfort Keepers is seeking a reliable, honest, caring individual's that enjoy spending time with the seniors in our...
  • 20 Days Ago

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Account Executive - Employee Benefits
  • AssuredPartners
  • Cockeysville, MD
  • Overview: As experts in protecting what matters most to businesses and individuals, were looking to bring on our next Ac...
  • 3/29/2024 12:00:00 AM

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Sales Executive- Employee Benefits
  • AssuredPartners
  • Madison, WI
  • Overview: Love what you do but not where you do it? As a Sales Executive at AssuredPartners, you will use your existing ...
  • 3/29/2024 12:00:00 AM

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Account Executive - Employee Benefits
  • Brown & Brown, INC.
  • Fort Lauderdale, FL
  • Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best...
  • 3/29/2024 12:00:00 AM

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Sales Executive- Employee Benefits
  • AssuredPartners, Inc.
  • Cranford, NJ
  • Please note that the duties below can vary based on the workflow of your local office. Prospect: involves using our Sale...
  • 3/28/2024 12:00:00 AM

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Sales Executive - Employee Benefits
  • Brown & Brown, Inc.
  • Irvine, CA
  • Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best...
  • 3/28/2024 12:00:00 AM

A
Sales Executive- Employee Benefits
  • Assured Partners
  • Houston, TX
  • Overview Love what you do but not where you do it? As a Sales Executive at AssuredPartners, you will use your existing s...
  • 3/28/2024 12:00:00 AM

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Sales Executive- Employee Benefits
  • Assured Partners
  • Franklin, TN
  • Overview Love what you do but not where you do it? As a Sales Executive at AssuredPartners, you will use your existing s...
  • 3/25/2024 12:00:00 AM

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Account Executive-Employee Benefits
  • National Financial Partners Corp.
  • Palm Beach Gardens, FL
  • Who We Are NFP is a seven-time Best Places to Work award winner in Business Insurance who has also earned the 5-Star Div...
  • 3/25/2024 12:00:00 AM

New Mexico (Spanish: Nuevo México Spanish pronunciation: [ˈnweβo ˈmexiko] (listen), Navajo: Yootó Hahoodzo pronounced [jòːtxó xɑ̀xʷòːtsò]) is a state in the Southwestern region of the United States of America; its capital and cultural center is Santa Fe, which was founded in 1610 as capital of Nuevo México (itself established as a province of New Spain in 1598), while its largest city is Albuquerque with its accompanying metropolitan area. It is one of the Mountain States and shares the Four Corners region with Utah, Colorado, and Arizona; its other neighboring states are Oklahoma to the north...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Top Provider Network Executive jobs
$364,356 to $674,708