Provider Contracts Manager

Were searching for a Provider Contracts Manager someone who works well in a fast-paced this position youll handle the analysis completion implementation and ongoing follow-up of primary care specialist and ancillary provider contracts while developing and maintaining positive relationships with providers and internal customers. Youll interact daily with attorneys directors managers and peers and will manage and complete major departmental projects including recommending project plans.

Think youve got what it takes

Job Duties & Responsibilities
Identifies providers who are eligible for participation in the provider network and who meet network and member needs
Conducts face-to-face and telephonic outreach to providers to initiate and follow up on contracts and credentialing materials
Ensures the provider contracting process is conducted in accordance with departmental policies procedures and regulatory requirements
Reviews managed-care contracts and ensures language and rates are within established parameters and guidelines
Facilitates the credentialing process for new providers and ensures contracts are executed by both parties and filed appropriately
Serves as a subject matter expert for provider contract configuration within the claims payment system
Serves as a subject matter expert on provider contract templates and responds to requests for contract interpretation
Prepares documentation needed for RFPs readiness reviews regulatory audits and other contractual audits
Develops and maintains standard pricing grids fee schedule crosswalks and reports to monitor contract performance
Attends weekly meetings with the manager to discuss the status of projects and contracting efforts
Communicates provider trends to management in a timely manner
Completes ad hoc reports and projects within assigned deadlines

Skills & Qualifications
High school diploma or equivalent required
4 years of applicable health care experience in a contracting provider relations business development or provider business office role required
Bachelors degree preferred
A bachelors degree may substitute for a portion of the required experience