Claim Manager organizing compensation claims and providing administrative support in public transport sector. Collaborating on negotiation processes and managing documentation for damage claims.
About the role
- Provider Contract Manager supporting the Director in developmental and management tasks for healthcare provider contracting operations while ensuring operational effectiveness and collaboration.
Responsibilities
- Support the Director, Provider Contracting & Strategic Growth with the development, implementation, and management of provider contracting operations processes
- Ensure operational effectiveness by assisting in strategic and business planning, including strategic initiative identification and resource planning and allocation
- Partner with leadership to determine and prioritize opportunities to achieve departmental and enterprise goals
- Participate in provider contract template development
- Provide proactive support, oversight, and management of Preferred, Acceptable, Discouraged, and Unacceptable (PADU) tool and Contract Review Committee (CRC)
- Collaborate with internal business areas on contract negotiations to understand and mitigate operational impacts
- Act as a provider contract management system subject matter expert including but not limited to facilitating user training, contract template management, system troubleshooting, and business requirements
- Facilitate in the development, implementation, and monitoring of departmental policies and procedures
- Support activities as assigned in relation to business development
- Recognize and proactively manage operational dependencies and risks across strategic initiatives and process improvements
- Participate in the process of estimating initiative budgets as well as developing business cases and tracking the benefits realization
- Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
Requirements
- Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required
- Master’s Degree or equivalent work experience is preferred
- Minimum of three (3) years of healthcare experience, to include one (1) year of work experience in managed care provider relations or provider contracting
- Minimum of three (3) years of experience in leading business initiatives to drive systemic change is preferred
- Managed care experience is highly preferred
- Proficient in Microsoft Office Suite (Outlook, Teams, Word, Excel, PowerPoint, and SharePoint)
- Experience with Visio is a plus
- Advanced-level knowledge of provider contracting processes and operations
- Working knowledge of complex provider organizational structures including but not limited to Accountable Care Organizations (ACOs), Clinically Integrated Networks (CIN), and Independent Practice Associations (IPAs)
Benefits
- Comprehensive total rewards package
- Bonuses tied to company and individual performance
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