Task and Responsibilities :

 Assist in managing the TPA's provider network, ensuring network adequacy, and

maintaining up-to-date provider directories.

 Coordinate with various departments to update and validate provider information in

the network.

 Act as a point of contact for network providers, addressing inquiries, and resolving

issues related to network participation.

 Support the Network Relations Manager in fostering positive relationships with

providers to enhance network satisfaction.

 Collaborate with the Provider Relations team in negotiating and executing provider

contracts.

 Ensure accurate and timely contract administration, including contract renewals

and amendments.

 Support the Network Relations Manager in identifying potential new providers to

expand and enhance the TPA's network.

 Assist in evaluating provider applications for network inclusion and compliance with

credentialing requirements.

 Ensure provider network compliance with regulatory standards, contractual

obligations, and accreditation requirements.

 Collaborate with the Compliance team to address any network-related compliance

issues.

 Assist in analyzing network data and provider performance metrics to assess

network effectiveness.

 Prepare reports on network utilization, provider demographics, and network trends

for management review.

 Collaborate with the Provider Credentialing team to facilitate the timely and

accurate credentialing of network providers.

 Provide support in collecting and verifying provider credentials and documentation.

 Work closely with other departments, including Claims, Quality Assurance,

Finance, and Operations, to ensure effective network operations and seamless

integration of providers into the network.

 Participate in the training and development of network relations staff to enhance

their skills and performance.

Skills

Experience:

 Minimum of 8 years of experience in healthcare network management, provider

relations, or a related field.

 Knowledge of provider network dynamics, provider credentialing, and healthcare

contracting.

 Proficiency in using Microsoft Office applications and database management.

 Understanding of regulatory and accreditation requirements related to provider

networks

Personal Attributes / Skills:

1. Customer service orientation

2. Analytical skills

3. Communication skills

4. Persuasive skills