Provider Contract Manager

Preferred Location Hybrid role with a strong preference for candidates located in the Northwest, OH region. Provider Contract Manager I Job Summary Under direct supervision, develops and maintains relationships with typically small to medium sized and/or moderately complex provider community via e‑mail, telephonic and face‑to‑face outreach. Develops the provider network and national network offerings through contracting activities, relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and the resolution of provider issues. Responsibilities Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks and with internal department staff. Explains contract provisions to internal/external customers. Prepares non‑standard contracts, amendments, and extensions. With some assistance, conducts non‑standard contracts, rate, and language negotiations. Compiles and analyzes data to support contracting negotiations and/or compliance. Serves as a communication link between assigned providers and the Company. Provides provider service and education, including field visits. Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers. Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, preparing agenda and meeting minutes. Identifies program/system enhancements to reduce/minimize issues going forward. May collaborate with other key areas on cross‑functional projects. Performs other duties as assigned. Education and Experience Bachelor's Degree in Business or Healthcare Administration, Finance, or related field. In lieu of Degree, may consider an equivalent combination of education and experience. Experience in health insurance or a health care related field preferred. Technical Skills and Knowledge Intermediate Microsoft Office skills, especially Excel. General knowledge of the health care industry and current events. Good project management skills. Knowledge of provider contract negotiations, regulations, etc. Good presentation skills. Provider Contract Manager II Job Summary Under general supervision, develops and maintains relationships with typically medium to larger sized and/or complex provider community via e‑mail, telephonic and face‑to‑face outreach. Develops the provider network and national network offerings through contracting activities, contract negotiations (language and rates), drafting contracts, amendments, and extension documents, managing relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and resolution of provider issues. Responsibilities Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks and with internal department staff. Explains contract provisions to internal/external customers. Compiles and analyzes data to support contracting negotiations and/or compliance. Researches and resolves complex issues that may impact future negotiations or jeopardize network retention. Reviews financial impact analyses, projections and develops negotiation work papers. Makes recommendations to assist in complex negotiations. Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, driving the meetings in the discussions of issues and changes. Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers. Serves as a communication link between all assigned providers or National networks and the Company. Provides provider service and education, including field visits. Collaborates with other key area on cross‑functional projects. Identifies program/system enhancements to reduce/minimize issues going forward. Performs other duties as assigned. Education and Experience Bachelor's Degree in Business or Healthcare Administration, Finance, or related field. In lieu of Degree, may consider an equivalent combination of education and experience. 2 years of experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field. Technical Skills and Knowledge Intermediate to advanced Microsoft Office skills, especially Excel and PowerPoint. In depth knowledge of the health care industry and current events. Strong project management skills. Thorough knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value‑based concepts. Strong presentation skills. Provider Contract Manager III Job Summary Under minimal supervision, develops and maintains relationships with typically larger and/or more complex provider community (e.g., institutional, PHO, primary care, multi‑specialty, ancillary, national providers, health systems) via email, telephonic and face‑to‑face outreach. Develops the provider network and national network offerings through contracting activities, contract negotiations (language and rates), drafting contracts, amendments, and extension documents, managing relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and resolution of provider issues. Provides coaching and mentoring to more junior Provider Contract Managers and support staff. Responsibilities Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks, consultants, and internal department staff. Explains contract provisions to internal/external customers. Manages contracts for off‑cycle relationships that are initiated during non‑renewal periods. Negotiates non‑standard contracts independently. Researches and resolves complex issues that may impact future negotiations or jeopardize network retention. Reviews financial impact analyses, projections and develops negotiation work papers. Makes recommendations to assist in complex negotiations. Compiles and analyzes data to support contracting negotiations and/or compliance. Performs in‑depth review of data and financial analysis supplied to Contracting. Serves as a subject matter expert and communication link between all assigned providers or National networks and the Company. Provides provider service and education, including field visits and seminars. Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers. Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, preparing agenda and meeting minutes, driving the meetings in the discussions of issues and changes. Collaborates with other key area on cross‑functional projects. Identifies program/system enhancements to reduce/minimize issues going forward. Orients, trains, assists and reviews work of more junior Provider Contract Managers and support staff. Performs other duties as assigned. Education and Experience Bachelor's Degree in Business or Healthcare Administration, Finance, or related field. In lieu of Degree, may consider an equivalent combination of education and experience. 3 years of experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field. Technical Skills and Knowledge Intermediate to advanced Microsoft Office skills, especially Excel and PowerPoint. Comprehensive knowledge of the health care industry and current events. Strong project management skills. Comprehensive knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value‑based concepts. Strong presentation skills. Strong financial acumen. Sr Provider Contract Manager Job Summary Under minimal supervision for decision making, develops and maintains relationships with typically the largest and most complex provider community via email, telephonic and face‑to‑face outreach. Develops the provider network and national network offerings through contracting activities, contract negotiations (language and rates), drafting contracts, amendments, and extension documents, managing relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and resolution of provider issues. Provides coaching and mentoring to more junior Provider Contract Managers and support staff and assists management with special projects. Responsibilities Negotiates and reviews complex non‑standard contracts to improve and/or keep competitive positioning that have the most strategic importance to the company. Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks, consultants, and internal department staff. Explains contract provisions to internal/external customers. Manages contracts for off‑cycle relationships that are initiated during non‑renewal periods. Researches and resolves complex issues that may impact future negotiations or jeopardize network retention. Reviews financial impact analyses, projections and develops negotiation work papers. Makes recommendations to assist in complex negotiations. Compiles and interprets financial data necessary to support contracting negotiations and/or compliance and draws conclusions to make informed decisions. Takes independent action within established departmental guidelines. Acts as Hospital/PHO, Ancillary, National Network relationship manager by assisting assigned providers with contract, claims, systems, education, and other concerns. Manages market areas by recommending and helping to implement strategies for the market. Participates and/or takes the lead in most challenging internal or external projects. Identifies and resolves program/system enhancements to reduce/minimize issues going forward. Serves as a subject matter expert and communication link between all assigned providers or National networks and the Company. Provides provider service and education, including field visits and seminars. Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers. Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, preparing agenda and meeting minutes, driving the meetings in the discussions of issues and changes. Orients, trains, assists and reviews work of more junior staff. Performs other duties as assigned. Education and Experience Bachelor's Degree in Business or Healthcare Administration, Finance, or related field. In lieu of Degree, may consider an equivalent combination of education and experience. 5 years of progressive experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field. Technical Skills and Knowledge Intermediate to advanced Microsoft Office skills, especially Excel and PowerPoint. Comprehensive knowledge of the health care industry and current events. Strong project management skills. Comprehensive knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value‑based concepts. Strong presentation skills. Strong financial acumen. Benefits and Compensation Employee bonus program. 401(k) with company match up to 4% and an additional company contribution. Health Savings Account with a company matching contribution. Excellent medical, dental, vision, life and disability insurance. Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self‑help resources and assistance with work/life benefits. Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time. After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption. Professional Development Career development programs and classes. Mentoring and coaching to help you advance in your career. Tuition reimbursement up to $5,250 per year, the IRS maximum. Diverse, inclusive and welcoming culture with Business Resource Groups. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Other Disclosures We maintain a drug‑free workplace and perform pre‑employment substance abuse and nicotine testing. #J-18808-Ljbffr