Network Coordinator, Workers Compensation

UPMC’s Health Plan and Workpartners are hiring a Network Coordinator for the Workers Compensation Case Management team. 

This is a remote position but will require approximately 15% travel and may require travel to Pittsburgh for meetings and trainings. This is subject to change based on business needs. 

The Network Coordinator is responsible for the expansion of Workpartners Workers Compensation network. This includes implementing provider cost containment strategies and other strategic plans developed by Workpartners management team to support new self-insured and commercial Workers Compensation business growth as well as network enhancement for existing clients. The Network Coordinators responsibilities include but are not limited to the following: 

Responsibilities:

• Analyze and execute network expansion opportunities, ongoingly in Pennsylvania (with specific focus on central and eastern markets) as well as all Workers Compensation expansion states.
• Maintain subject matter expertise for all states Workers Compensation contracting laws where Workpartners is licensed to write premium.
• Investigate sales/marketing requests concerning the recruitment of physician, ancillary and facility providers.
• Identify potential network provider leads and enter into contractual negotiation. 
• Ensure timely execution of network contracts, develop recruitment and training materials, and educate providers on network provider expectations.
• Maintain existing relationships with contracted providers. 
• Ensure contractual language is kept current; evaluate fee schedule(s) on a annual basis to identify possible opportunities.
• Negotiate and implement cost containment strategies including but not limited to facility, provider and ancillary medical spend. Facilitate the approval process of all contract documents from pre-contract through post-signature phases.
• Maintain accuracy of supporting documentation for all network processes.
• Develop and maintain processes that provide timely notification of critical contract events, such as due dates, renewal, termination, etc.
• Assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes.
• Analyze all network activity including vendor and other networks used in repricing of medical bills. Identify and develop additional reporting if needed. Implement measures to facilitate greater cost containment.
• Develop, prepare and present reports on the status of contracts.
• Assist with development, preparation and presentation of network performance as requested.
• Participate in the management of medical vendor relationships.
• Function as the primary point of contact for resolution of vendor/payor disputes.
• Maintain excellent written and verbal communication with all internal and external customers.
• Assist with all contracting administration and projects, as needed or directed. Collaborate with Care Channel and Provider Relations teams to bridge provider network gaps and needs.
• Work collaboratively with network management, IT, legal, compliance and other internal health plan departments regarding procedural, operational, credentialing and contractual processes. Serve as the main point of contact for network issues or questions.
• Present network performance and bring forth network expertise to strategic business development discussions.
• Educate and train all Workpartners staff with regards to network capabilities.
• Manage the maintenance and administration of network databases including contract repository and linkage to panel tool.