The Director of Network Relations is responsible for developing and executing provider network strategy, including complex contract negotiations and value-based arrangement design. They also oversee network adequacy compliance, manage the network relations team, and partner with actuarial teams on fee schedule benchmarks.
The role involves leading the technical direction and architecture of the backend platform while remaining hands-on with Node.js and TypeScript service development. Responsibilities include mentoring junior engineers, establishing coding standards, and ensuring high-availability, HIPAA-compliant system performance.
The representative manages inbound and outbound inquiries from members and providers regarding health plan benefits, eligibility, claims, and billing. They are responsible for resolving issues at first contact, documenting interactions in the CRM, and collaborating with internal teams to address complex situations.
