To expand and maintain a provider network, I would focus on building strong relationships with healthcare providers through regular communication and understanding their needs. I would also leverage data analytics to identify gaps in the network and target areas for expansion. Ensuring provider satisfaction by addressing their concerns promptly and offering competitive contracts is crucial. Additionally, I would stay updated on healthcare regulations and market trends to adapt strategies accordingly, ensuring the network remains robust and meets the organization's goals.

Ensuring compliance involves staying informed about current healthcare laws and regulations, such as HIPAA and the Affordable Care Act. I would implement regular training sessions for the network team and providers to keep them updated on compliance requirements. Additionally, I would conduct periodic audits of provider practices and documentation to ensure adherence to regulations. Collaborating with legal and compliance teams to review contracts and policies is also essential to mitigate risks and maintain a compliant network.

In a previous role, a provider was dissatisfied with reimbursement rates, threatening to leave the network. I initiated a meeting to understand their concerns and presented data showing how our rates were competitive within the market. We discussed the value of our network's patient volume and negotiated a mutually beneficial agreement, including a slight rate adjustment and improved payment timelines. This approach not only retained the provider but also strengthened our relationship, demonstrating the importance of open communication and flexibility in conflict resolution.

I have utilized various tools like CRM systems for tracking provider interactions, credentialing software to manage provider enrollments, and data analytics platforms for network performance analysis. These tools streamlined processes, improved accuracy in provider data management, and enabled efficient tracking of contract terms and compliance status. By leveraging technology, I was able to enhance operational efficiency, reduce manual errors, and make data-driven decisions to optimize the provider network's performance and satisfaction.

Success is measured through key performance indicators such as provider satisfaction scores, network adequacy, patient access to care, and cost-effectiveness. Regular surveys and feedback mechanisms help gauge provider satisfaction, while data analysis assesses whether the network meets patient needs geographically and specialty-wise. Monitoring claim denial rates and reimbursement efficiency provides insights into financial performance. Ultimately, a successful provider network balances quality care, provider engagement, and operational efficiency, aligning with the organization's strategic objectives.