Plans, organizes, and executes all activities in continued development, maintenance and implementation of the Encompass Specialty Surgical Network in assigned geography. Leads current client implementation and provider strategies to effectively manage orthopedic, spine and surgical services for Workers Compensation patients. Supports and implements Episode of Care solutions and other product development initiatives.
- Represent the Encompass brand and its commitment to improving the quality of orthopedic and spine surgical care in the Workers Compensation space.
- Develops and implements provider network and contract strategies, identifying the ambulatory surgery centers and specialists in geographic locations in which to concentrate resources for purposes of establishing a sufficient network of participating providers to serve and exceed the needs of our clients.
- Executes provider contracts for acceptable reimbursement rates as determined by client requirements and Encompass targets.
- Develops and maintains working knowledge of key regulatory requirements in assigned geography including state specific panel requirements.
- Builds and maintains relationships with key client personnel including Claims Office Managers, Adjustors, Case Managers and Employer Groups.
- Represent Encompass at select state and national trade shows/conferences.
- Partner with internal team members to coordinate gap filling activities.
- Requires ability to travel 2-3 days/week.
- Maintains all network development and client sales activity in CRM applications
- Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines with ambulatory surgery centers and physician groups.
- Oversees the maintenance of all Provider contract information for given territory. Works with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
- Complies with required workplace safety standards.
- Adheres to the company and/or departmental confidentiality standards and HIPAA compliance programs.
- Adheres to the company and/or departmental fraud and abuse prevention/detection policies and programs.
- Other duties, as assigned.
- Superior written and verbal communication skills.
- Knowledge of MS Excel, PowerPoint and Word.
- Superior interpretation and research skills to readily identify problems, get to the root cause and achieve prompt resolution to problems and issues including analytical skills.
- Ability to organize, coordinate, and accomplish a high volume of work with minimum impact on quality.
- Exceptional interpersonal relations skills.
- Ability to maintain attendance to support required quality and quantity of work.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
- Bachelor’s Degree in a related field (Business Administration, etc.,) or equivalent experience
- 7 – 10 years’ experience in Workers Compensation industry sales and/or provider sales in the orthopedic/spine surgical space.
- Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
|Job Category||Network and Client Management|