Provider Contract Manager

Location Preference This role is hybrid with a strong preference for candidates located in the Northwest, OH region. 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. Qualifications 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. Comprehensive knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value‑based concepts. Benefits A Great Place to Work: We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset. Whether you are working remote or in the office, employees have access to on‑site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more. On‑site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters. Discounts at many places in and around town, just for being a Medical Mutual team member. The opportunity to earn cash rewards for shopping with our customers. Excellent 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 – insurance is what we do best, and we make affordable coverage for our team a priority. 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. An Investment in You: 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. We maintain a drug‑free workplace and perform pre‑employment substance abuse and nicotine testing. #LI-CS1 #LI-HYBRID Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 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. #J-18808-Ljbffr