Network Operations Lead (Hybrid)

Harbor Health looking for an engaging Networks Operations Lead to become a member of our team! Harbor Health is an entirely new multi-specialty clinic group in Austin, TX utilizing a modern approach to co-create health with those who get, give, and pay for it, allowing everyone to fully flourish. Join us as we build a fully integrated system that connects care to a better payment model that truly puts the human being at the center.

The Network Operations Lead will be accountable for developing and maintaining relationships with physicians and other health care providers in Harbor's contracted network. As the primary point of contact for the contracted provider network you will own growing and maintaining a solid network of healthcare professionals ensuring the availability of high-quality healthcare services to Harbor members.

You will establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs through direct and in-person, regular contact and communication.

Our Network Operations Lead will be responsible for:

• Responsible for Network Development and Maintenance
  • Primary point of contact for all contracted network participants to ensure their success within Harbor’s programs and plan offerings, Specifically;
    • Educate providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
    • Meet with key providers periodically to develop provider relationships, address concerns and ensure service levels are meeting expectations.
    • Onboarding/Offboarding and Training 
    • Provider communications
    • Perform credentialing support activities as needed.
    • Assist in developing and executing organic network growth and expansion strategy within the market
    • Primary network contact for all contracted groups for provider data and roster management.  Will work across the network and within Harbor to ensure accuracy and usability of provider network roster data for the provider directory, Harbor’s third party administrator, regulatory agencies and other relevant uses.
• Adequacy Analysis: 
  • Constantly reviewing the network and working with internal resources to;
    •  Ensure the network meets adequacy and accessibility standards and that necessary regulatory filings are prepared and maintained. 
    • identifying network gaps and executing a plan to fill identified gaps.
• Regulatory Reporting and Data Analytics: Submit required reports and analyze network data.
• Respond timely to provider issues
  • Work across Harbor to resolve issues and updates providers and office staff regularly through to resolution. 
  • Resolve provider disputes and claims issues.
• Reviews, analyzes, and monitors physician experience/satisfaction, growth, population health, and value-based measures
• Knowledgeable about incentive programs, contract reimbursement, Harbor’s internal processes and priorities, and other Harbor initiatives, as applicable to the network
• Provider Handbook dissemination and network education
• Works collaboratively across Harbor to help drive membership growth and retention
• Actively engage in affiliated network expansion and retention efforts
• Takes personal responsibility for the success of each network participant and guides each partner to success.

Successful Network Operations Leads will have:

• 5 years of relevant healthcare insurance or relevant network experience, including external health plan provider network build and management.
• Undergrad degree
• Relationship management experience in a health plan or network focus on the success and retention of network participants.
• Demonstrated ability to work with provider groups to ensure timeliness, accuracy and usability of roster information as detailed above
• Demonstrated ability to work independently, hit deadlines and prioritize deliverables in a way that drives the most value for the company
• Experience with health benefits, plan design and language
• Demonstrated success operating high-growth companies 
• Data analysis skills including the ability to pull & analyze data from source system
• Strong base knowledge of Office and/or Google suite software products

• Previous Project Management Experience. 

• Experience developing and administering value-based payment arrangements
• Understanding of relevant healthcare payor functions like claims processing and various payment rate methodologies and calculations. 
• Network Build and/or  Physician Outreach/Sales experience is also a plu

• Up to 25% travel with the defined service area
• Ability to work from home, but it is strongly preferred that the candidate live in or close to the network service area.

If you are passionate about health care and you want to create something new together, we want you to be apart of our team!