Provider Contracting/Network Manager-Healthcare

Location: Atlanta, GA
Date Posted: 06-11-2018
Job description
This position reports to the Director of Provider Contracting & Network Management to support the contracting activities of the Medical Group and Health Plan. Contracting activities continue to grow substantially in volume, financial impact, and complexity. Existing contracts must be continually renegotiated and aggressively managed. Areas of responsibility will include IPAs, PHOs, hospitals, and key specialty services. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care; negotiation in hospital, PHO/IPA and various high volume services.

Essential Functions:
• Successfully negotiate contracts for cost reduction or contract and relationship maximization with specialty service providers. This includes facilities, individuals, networks, using a diverse range of techniques and contracting ''best practices'', to include capitation, case rates, and various fee for services arrangements.
• Management of Provider Relations Staff (5 FTEs) and mentor 2-3 Network Managers to successfully support the goals of the organization, set up goals and initiatives for provider relations staff to achieve.
• Execute and manage multiple expansion related priorities for Region.
• Develop, manage and implement Region-wide contracting strategies. This includes specialty services and the alignment of contract interests of TSPMG, Health Plan, and Network providers.
• Provide ongoing intervention and assistance in the management of claims, UM and benefit issues.
• Collaborate with Performance Analysis to identify cost savings initiatives and monitor contract performance.
• Ensure contract compliance with all requirements as set forth by State and Federal agencies.
• Work closely with QRM to identify out of network providers and implement Letters of Agreement that reduce financial exposure.
• Supervise and execute special projects as assigned by Director.

Basic Qualifications:
• BS/BA in business administration, finance or health care
• Minimum of 7 years of experience in health care administration
• Possess a successful track record of negotiating large hospital system contracts
• Ability to budget and obtain necessary medical cost targets
• Strong understanding of financial reports and the ability to manage accordingly
• Understand contract language and legal requirements for contracting
• Strong understanding of State and Federal Laws related to provider contracts
• Strong understanding of Medicare contracting and reimbursement methodology
• Broad based knowledge of health care and the various medical delivery systems
• Understanding of various financial reimbursement methodologies used in managed care contracts; CMS DRGs, Revenue Codes, APCs, RBRVS and ASC Groupers
• Negotiation, analytical skills and human interaction skills
• Excellent organizational and prioritization skills, the ability to work under tight deadlines, high productivity
• Strong written and excellent communication skills
• Management skills to lead a team of field representatives
• Strong presentation skills

Preferred Qualifications:
• Masters Degree, MBA or MHA
• Managed care contracting or health care finance
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!

This position does NOT provide sponsorship so please do NOT apply if you require sponsorship.  Thank You

KP Recruiting Group 
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