COE Network Referral Specialist (Healthcare)-Work From Home

Multiplan  United States of America

Posted: February 15, 2017 | Job Type: Full Time

Full-time, Contract


Network Development Specialists – are you looking for a rewarding new position with an industry leader with a firm commitment to its employees? Join our team at MultiPlan! Founded in 1980, we are the industry’s most comprehensive provider of healthcare cost management solutions. We have almost 1,000,000 healthcare providers under contract, an estimated 68 million consumers accessing our network products, and 40 million claims reduced through our network and non-network solutions each year.


As a COE Network Referral Specialist , you will be responsible for providing internal and external client and provider service related to the Centers of Excellence Transplant Network program. This includes identifying and evaluating opportunities and resolving conflicts to improve patient access to the highest quality, cost-effective providers of transplant related healthcare services in accordance with applicable regulations and the Company’s policies, practices and procedures.
Your specific duties in this role will include:
1. Research and maintain reports of competitive market tends and client expectations through comprehensive, aggressive execution of client interactions and training derived from national and regional objectives related to penetration and discount objectives, and improved customer service and referral sources.
2. Foster and maintain current knowledge of solid organ and stem cell transplantation treatment, trends and terminology
3. Foster and maintain superior provider and client (internal and external) relationships.
4. Maintain, and preferably exceed, proactive client outreach goals and departmental standards consistent with promoting the Centers of Excellence Transplant Network to clients and providers alike. In addition, support general Network Development goals where needed.
5. Prepare and maintain analyses, reports and presentations by collecting, analyzing, and summarizing information and trends.
6. Be skilled at understanding Centers of Excellence contract methodology, transplant terminology and clinical flow and be available to provide consultation to internal claims and external customers and providers.
7. Work with Regional Sales and Accounts Management Peers to promote the Centers of Excellence Transplant Network and respond to and anticipate access requirements and network related performance requests. Participate in the maintenance and use departmental and market information to assess network adequacy and competitiveness in region
8. Work closely with Director to complete additional special projects required to service internal and external clients as well as to support departmental record keeping needs.
9. Participate in departmental team meetings and national team training sessions.
10. Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources.
11. Ensure compliance with established policies and procedures and with regulatory requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources).
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Demonstrate Company’s Core Competencies and values held within.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.


As a COE Network Referral Specialist , you must be highly organized and detail-oriented, with strong analytical, problem solving, prioritization and negotiation skills. You should also be able to handle multiple tasks in a fast-paced, deadline-driven environment, both independently and as part of a team. It is also important that you display excellent verbal and written communication and interpersonal skills, as well as the ability to effectively present information and respond to questions from groups of managers and clients.

Specific qualifications for the role include:

• Minimum Bachelor’s Degree in related nursing, healthcare or applicable field, or HS Diploma (or GED) and four (4) years’ experience related to network development, claims management and/or transplantation.
• Minimum 1 year experience in provider contracting and network development, or equivalent provider/payer experience, successfully interpreting contract language and payor claims processes.
• Knowledge and understanding of provider transplant finance components including patient financial approval, payor benefit language, charge structure, reimbursement formulas and healthcare finance a plus. Ability to acquire these skills would be required.
• Knowledge of provider organizations and operations applicable to transplant services.
• Knowledge of transplant clinical care and patient acceptance transplant procedures and/or demonstrated ability to learn clinical components to transplant care.
• Communication (written, verbal and listening), business acumen, organization, strategic, multitasking, prioritization skills and presentation skills (in-person and/or electronic).
• Ability to demonstrate client and provider interactions by developing skills necessary to strategize, construct, and oversee client and member access to complex financial rate structures and contract language
• Ability to be a self-starter and work independently.
• Ability to successfully manage multiple competing priorities.
• Ability to elicit trust and credibility with all levels of the organization
• Ability to effectively communicate the MultiPlan Value Proposition.
• Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries
• Ability to build relationships with internal and external customers and providers
• Ability to use computer software, hardware, and peripherals applicable to role
• Up to 25% travel possible, primarily to meet with customers on an occasional basis and, at times, with little advance notice, as well as travel to attend MultiPlan sponsored meetings and appropriate professional conferences


As a COE Network Referral Specialist with MultiPlan, you will be part of an organization with a proud 30-year legacy of experience and growth. We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

• Medical, dental, and vision coverage
• Life insurance
• Optional and dependent life insurance
• Short- and long-term disability
• 401(k)
• Paid time off
• Paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program

Opportunity. Recognition. Satisfaction. Grow your career with MultiPlan!

Apply now!

As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.

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