Client Relationship Manager

Client Relationship Manager

Artech is an employer-of-choice for over 5,800 consultants across the globe. We recruit top-notch talent for over 65 Fortune and Government clients coast-to-coast across the U.S., India, and China. We are one of the fastest-growing companies in the U.S. and this may be your opportunity to join us!

Job Description

Duration: 12 Months Contract To Hire

Location: Harrisburg / Pittsburgh PA

Responsible for development and management of provider networks for all products: Medicaid, and Medicare.

Responsible for hospital and physician network development and management.

Develops and recommends policy changes related to provider recruitment and contracting.

Recruits and negotiates contracts with specific providers within operational and potential new counties to meet company requirements.

Oversees training and communication for network providers and acts as a liaison with the provider community.

Ensures compliance with pricing guidelines established by AMFC and Plan.

Ensures provider contracting is consistent with claim payment methodologies.

Maintains familiarity with Medicare and State Medicaid fee schedules and reimbursement methodologies and analyzes comparable Plan pricing guidelines.

Resolves difficult complex contract issues to ensure that provider contracts are in compliance with state, federal, national accrediting agencies and Plan contracting guidelines.

Ensures that non-standard contract elements are communicated to appropriate departments and obtains AMFC and Plan approval prior to submission to provider.

Responsible for the accuracy and timely management of all provider contracts.

Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims.

Responsible for achievement of quality and health plan objectives through accomplishment of provider initiatives

Qualifications

Bachelor's degree in business or health related discipline such as Healthcare Administration or Healthcare Management or equivalent business experience required

Master's Degree highly preferred.

Minimum of 5 years provider contracting/reimbursement experience in healthcare setting required

1-2 years Medicaid experience required

Careers Integrated Resources Inc