Provider Relations and Contracting Specialist

This role provides critical operational support to the Client Business Manager team while assisting with day-to-day provider relations contracting network operations and a wide range of client support activities. The position assists where operational help is needed to continue servicing our clients at a high level. This includes supporting contracting follow-up responding to inquiries handling operational aspects of the provider network and delivering broad assistance to the assigned Client Business Manager(s) on various client-related tasks. This is a developmental role designed to deliver immediate capacity relief while building the skills and knowledge needed to eventually take on full Client Business Manager responsibilities as the organization grows.

WHAT YOULL BE DOING

• Coordinating and providing care management and care that is timely effective efficient equitable safe and member centered.
• Managing case assignments (outreach documentation case progression and case closures) meeting reporting and documentation standards and engaging in collaborative meetings with clients.
• Monthly attendance and coordination of UM/PHM Committee Meetings including material preparation minutes data collection and analysis reporting and follow-up tasks.
• Training new and current employees with Preceptors.
• Re-education for audit fallouts.
• Assisting in creating re-evaluating and updating workflows/processes.
• Updating internal knowledge base and Confluence pages.
• Assisting in creation re-evaluation and analysis of necessary reporting and identification of reporting opportunities.
• Attending and participating in virtual and in-person leadership meetings as necessary.
• Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Nurse Practice Act.
• Other responsibilities as assigned including assisting with payroll and monitoring FTO requests as well as completing coaching and performance reviews with the team.
•  Communication with IPA Administrators and Client Business Managers to ensure resolution of any concerns.

Qualifications :

WHAT YOULL NEED FOR SUCCESS

• 3 years of experience in provider relations provider contracting network management or client support in healthcare (health plan IPA MSO or managed care strongly preferred) 
• Solid understanding of provider contracting credentialing claims processing authorizations and healthcare operations 
• Strong relationship-building and communication skills equally comfortable working with providers/office staff and health plan/client leadership 
• Highly organized with excellent project management follow-through and prioritization skills 
• Proficiency with Microsoft 365 (Excel Teams PowerPoint) and comfort learning multiple healthcare platforms and portals 
• Ability to thrive in a fast-paced fully remote environment while collaborating across teams 

WHAT WED LOVE FOR YOU TO HAVE

• Located in or around the Chicago metro area with the ability to travel to and from client meetings as needed 
• Experience supporting or working in a Client Business Manager Account Manager or Client Success role 
• Background in value-based care or IPA network operations 
• Familiarity with reimbursement models (fee-for-service capitation carve-outs) and network adequacy requirements 
• Bachelors degree in healthcare administration business or related field.

Additional Information :

The salary range for this role is $48000.00 to $51000.00 per year based upon experience.

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth our values come to life in everything we do. 

• We are Driven by Accountability grounded in transparency reliability and integrity as we navigate challenges and opportunities alike. 
• Always Growing Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation we solve problems creatively making every experience better for our employees and the patients we serve. 
• At Guidehealth Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth. 

BENEFITS:

While you are hard at work advancing value-based healthcare we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical Dental and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those just in case moments. Additionally we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles the responsibilities would be further defined by the hiring manager. 

As a remote-first organization handling sensitive healthcare data Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy data security and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. 

SECONDARY EMPLOYMENT

At Guidehealth we value transparency and collaboration as part of our commitment to excellence. As your primary employer we kindly ask all team members to disclose any secondary employment regardless of whether it may present a potential conflict of interest. 

To ensure smooth teamwork and availability employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.

Remote Work :

Yes

Employment Type :

Full-time