Provider Contracting Manager jobs in the United States

Provider Contracting Manager manages contracting activities for a healthcare provider network. Oversees and monitors a contracts database system for a healthcare provider network to track, monitor, and record contract data. Being a Provider Contracting Manager assists in negotiating with facilities joining the health network and setting rates. Implements reporting standards to ensure consistent recording of contract data and ensure compliance with regulatory requirements. Additionally, Provider Contracting Manager analyzes various rate scenarios to forecast and evaluate rate setting strategies and identify trends. Requires a bachelor's degree. Typically reports to a director. The Provider Contracting Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Provider Contracting Manager typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)

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Manager, Provider Services and Contracting
  • Independent Living Systems
  • Miami, FL FULL_TIME
  •  ABOUT US

    Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

     

    Position Summary

    Assist in development and maintenance of a comprehensive network of long-term care, ancillary, primary care provider, specialty physician, and hospital providers for Florida Community Care/ Independent Living System programs and products. Negotiate contracts, and act as point of contact for ongoing contractual and provider service issues.

     

    Essential Functions 

    1. Ability to negotiate all types of managed care contracts, including long term care, ancillary, PCP, specialist, and hospital agreements. Able to negotiate competitive reimbursement rates, and contract language changes as necessary.
    2. Maintain complete and updated knowledge of managed care reimbursement methodologies, market competitive rates, and contractual structures.
    3. Serve as the project manager for contract implementation: if applicable, oversee preparation and loading of contracts into computer systems.  Maintain and audit provider network file and directories.
    4. Monitor network adequacy and work to identify and resolve gaps with direct provider outreach and use of consultants. 
    5. Resolve provider service issues relating to claims, capitation, eligibility, network changes, and contract loading.  In addition, initiate and coordinate credentialing of new additions to ILS.  
    6. Review, investigate and resolve provider service issues in conjunction with ILS internal departments.  Analyze and research service care log data and claims data to develop proactive strategies to address provider issues and work with necessary departments to resolve.
    7. Oversee ongoing contracting and renewal of providers with Director of Provider Services.  Support evaluation and modification of provider network to ensure plan performance and growth.
    8. Work closely with Provider Relation Account Executives to identify and facilitate resolution of issues and provider concerns.
    9. Participate in the SCL process to support the provider call center in resolving provider identified issues.
    10. Coordinate with ILS’ Correspondence Team the monthly provider complaint report for submission to AHCA; and trend and track complaints and SCLs to determine strategies to improve provider relations.
    11. Other duties as assigned.

     

    Education and Experience

    • Bachelor's Degree and at least three (3) years of provider contracting experience.
    • Proficiency of Microsoft Office applications including Office, Excel, and Outlook.

     

    Required Skills

    • Ability to Lead team(s), motivate others and engage others at all levels.
    • Formal presentation skills required.
    • Ability to analyze complete concepts including Provider Reimbursement methodologies, reports, etc. and provide resolution within required timeframes.
    • Effective Highly organized and self-motivated.
    • Capable of working independently.
    • Ability to interact with people of all ages and cultural backgrounds.

     

    EEO STATEMENT 

    In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

     

  • 2 Months Ago

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Senior Provider Contracting Manager
  • FourStone Partners
  • West Chester, PA FULL_TIME
  • FourStone Partners is an innovative consulting firm specializing in business development, sales outsourcing, and operational support services within the Workers' Compensation industry. FourStone Partn...
  • 10 Days Ago

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Manager, Provider Contracting
  • Humana
  • Tampa, FL FULL_TIME
  • Become a part of our caring community and help us put health first The Manager, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreem...
  • 17 Days Ago

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Construction Project Management Training 2025 Program - Associate Contracting Project Manager
  • Associate Contracting Project Manager - Trane Technologies Careers
  • Wilmington, MA FULL_TIME
  • At Trane TechnologiesTM and through our businesses including Trane® and Thermo King®, we create innovative climate solutions for buildings, homes, and transportation that challenge what’s possible for...
  • 2 Months Ago

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Construction Project Management Training 2025 Program - Associate Contracting Project Manager
  • Associate Contracting Project Manager - Trane Technologies Careers
  • Chapin, NJ FULL_TIME
  • At Trane TechnologiesTM and through our businesses including Trane® and Thermo King®, we create innovative climate solutions for buildings, homes, and transportation that challenge what’s possible for...
  • 2 Months Ago

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Construction Project Management Training 2025 Program - Associate Contracting Project Manager
  • Associate Contracting Project Manager - Trane Technologies Careers
  • Rochester, NY FULL_TIME
  • At Trane TechnologiesTM and through our businesses including Trane® and Thermo King®, we create innovative climate solutions for buildings, homes, and transportation that challenge what’s possible for...
  • 2 Months Ago

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Contracts Manager
  • Maxar Technologies
  • Herndon, VA
  • Please review the job details below. Maxar has an opening for a Contracts Manager to join our team in Herndon, VA, Color...
  • 11/10/2024 12:00:00 AM

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Contracts Manager
  • RTX Corporation
  • Sterling, VA
  • Date Posted: 2024-09-10 Country: United States of America Location: VA543: 22270 Pacific Blvd, Dulles 22270 Pacific Boul...
  • 11/10/2024 12:00:00 AM

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Contracts Manager
  • Raytheon Technologies
  • Sterling, VA
  • Date Posted: 2024-09-10 Country: United States of America Location: VA543: 22270 Pacific Blvd, Dulles 22270 Pacific Boul...
  • 11/9/2024 12:00:00 AM

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Contracts Manager
  • Leonid Group Ltd
  • Arlington, VA
  • About the company & role An established brand in the Aerospace and Defence sector is currently seeking a Contracts Manag...
  • 11/8/2024 12:00:00 AM

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Contracts Manager
  • FIBERTEK, INC.
  • Herndon, VA
  • Fibertek, Inc. is a leading developer of laser and electro-optic systems for the aerospace community, with key contribut...
  • 11/7/2024 12:00:00 AM

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Contracts Manager
  • Aces Incorporated
  • Columbia, MD
  • Job Title: Contracts Manager Overview: EverWatch is a government solutions company providing advanced defense, intellige...
  • 11/7/2024 12:00:00 AM

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Contract Manager
  • Sparks
  • Arlington, VA
  • Provide on-site contract management advice to business units and project teams. Initiate, track, and monitor contract ch...
  • 11/6/2024 12:00:00 AM

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Contracts Manager
  • Leidos
  • Reston, VA
  • Description Leidos, Inc. has an exciting opportunity for a Contracts Manager to support our National Security Sector in ...
  • 11/6/2024 12:00:00 AM

Income Estimation for Provider Contracting Manager jobs
$118,761 to $154,480