Dispute Prevention & Resolution - Develop and enforce network policies and workflows to provider reimbursement disputes related to PPO discounts, provider contracts, and post-bill review reductions.
- Analyze provider appeals and adjustments to identify trends and root causes, recommending data-driven improvements.
- Collaborate with legal, clinical, and compliance teams to resolve provider disputes efficiently and consistently.
- Promote proactive communication with providers to enhance understanding of reimbursement processes and reduce conflict.
Performance Measurement & Optimization - Design and maintain network performance dashboards tracking metrics.
- Collaborate with analytics teams to evaluate network quality, effectiveness, and impact on claims outcomes.
Product Development & Enhancement - Own the lifecycle of network-related solutions that enhance compliance, savings, and stakeholder satisfaction.
- Translate client requirements and regulatory changes into actionable product improvements.
- Monitor market and regulatory trends to guide product innovation and maintain competitive advantage.
Cross-Functional Leadership & Collaboration - Serve as the subject matter expert on network products, provider performance, and dispute processes.
- Partner with internal teams—including sales, account management, RFPs, and product launches.
- Collaborate with external vendors and partners
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