Contract Manager
Network Health WI
full-time
Posted on:
Location Type: Hybrid
Location: Menasha • Wisconsin • United States
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About the role
- Successfully manages the Managed Care Contracting prospective, renewal and termination negotiation processes as they relate to: Network Health, HMO/POS; third party administrators and self-funded employers, Accountable Care Organizations (ACO).
- Accountable for establishing and maintaining positive relationships with internal departments, Network Health executive leadership and for any of the following prospective and/or existing external group: Network Health HMO/POS and third-party administrators.
- Serves as the individual accountable for the overall relationship between Network Health and selected contracted providers.
- Specific duties include establishing the initial contact with contracted providers setting and/or maintaining the tone for the desired Network Health provider agreements.
- Conducts managed care contracting related research and analysis including developing compensation/reimbursement structures and contract terms/conditions.
- Evaluates best-fit options for continued negotiations.
- Prepare executive summaries and recommendations.
- Initiates contract implementation process.
- Maintains effective communication throughout contract terms and communicates contract updates and changes as needed.
- Requests audits from the Provider File Specialist and evaluates contracting terms.
- Provides leadership for department, and Network Health special projects
Requirements
- Bachelors degree in a related field is preferred or eight years of equivalent experience may be substituted.
- Minimum of four years of experience in the health care industry (hospital, health insurance, or physician practice).
- Minimum of two years health services negotiation and provider/customer service experience, preferably health insurance and/or provider.
- Advanced health care financial, reimbursement and utilization data and analysis skills.
- Working knowledge of medical terminology, health care billing/coding, reimbursement and insurance benefit methodologies.
- Exceptional customer service/relationship management skills.
- Ability to prioritize multiple tasks and projects.
- Self-guided and motivated to achieve deliverables in a timely fashion.
Benefits
- Health insurance
- Paid time off
- Remote work options
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
managed care contractingnegotiation processescompensation structuresreimbursement analysiscontract termshealth care financial analysisutilization data analysismedical terminologyhealth care billinginsurance benefit methodologies
Soft Skills
relationship managementcustomer servicecommunicationleadershipprioritizationself-motivationtimely deliverables
Certifications
Bachelor's degree