Manager – Provider Relations & Contracting

Manager – Provider Relations & Contracting

Requirements

• Bachelor’s degree in related field or equivalent experience
• Master’s degree preferred
• 5+ years of contracting, network development and/or provider relations experience
• Project management experience
• Experience in a healthcare or insurance environment, preferably in Medicaid
• Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff

Responsibilities

• Implement development activities for the recruitment, contracting and retention of providers
• Negotiate contracts and develop strategies and methodologies for specific network development initiatives
• Monitor business processes related to provider contracting to determine their efficiency and protective value, and assure integrity of records, information and systems in compliance with Company policies/standards and government regulations
• Prepare provider contracts and monitor process to ensure timely execution of contracts
• Manage fee schedules, ensuring timely and accurate loading in company IS system
• Monitor and oversee provider contract compliance and issue corrective action letters for non-compliance
• Conduct and oversee administrative audits of provider agencies
• Prepare and analyze reports and records on functional area and on organizational activities, recommend improvements for upper management
• Monitor operational and financial performance of agreements using results to guide future negotiations
• Meet individually with providers to develop long-term relationships and resolve operational issues
• Review redline contract language and provide accept/decline recommendations to management
• Travel up to 50% for provider meetings and team meetings

Preferred Qualifications

• Master’s degree preferred