Senior Director Network Operations

Company: Valid8 Financial, Inc.
Location: Austin
Posted on: June 2, 2025

Job Description:

Remote with occasional travel (5%)10+ years of experience with health plan or provider organizationsResponsibilities

• Manage the provider contracting process for a rapidly growing health plan, including
  • Assuring that negotiators are efficient in their use of the correct documents
  • Assuring that contracts are meeting standards
  • Assuring contracts flow smoothly through the processes and that ClaimsOperations can load the contract into our claim system.
  • Lead the implementation of process improvements, including streamlining processes, adding automation and implementing new tools and vendor solutions.
  • Collaborate with network contracting colleagues, as well as legal department, compliance, credentialing and claim operations to optimize and streamline the entire contracting process.
  • Establish an end-to-end provider contract review policy and procedure incorporating the negotiation of language and rates to the entry in the claim system.
  • Manage all policies and procedures impacting the network development and credentialing teams; including development of new processes.
  • Lead the market fee schedule governance committee and ensure compliance with federal and state regulations.
  • Own and update the provider resources, as needed, to comply with regulations or expansion; including but not limited to the Provider Manual.
  • Identify potential risks associated with contracting activities and propose mitigation strategies.
  • Assist with internal and external audits.
  • Partner with Compliance to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity.
  • Create and maintain a library of approved "Model Contracts" for hospitals, physicians/group, and ancillary providers.
  • Reduce/eliminate rework or mitigation of unfavorable contract terms over time.Position Requirements
    • Bachelor's degree or equivalent experience in related field, including 10+ years of work experience beyond degree within provider contracting and/or health insurance.
    • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
    • Experience with physician group and ancillary provider contracting language and reimbursement.
    • Experience with credentialing.
    • Experience improving provider data accuracy.
    • Demonstrated experience in seeking out, building and nurturing strong internal and external relationships.
    • Team player with proven ability to develop strong working relationships within a fast-paced organization.
    • Customer centric and interpersonal skills are required.
      #J-18808-Ljbffr

Keywords: Valid8 Financial, Inc., College Station , Senior Director Network Operations, Executive , Austin, Texas