Ancillary Contract Manager- 100% Remote

MEDLOGIX, LLC•Hamilton Township, NJ

5h•Remote

About The Position

This position is responsible for the overall development and maintenance of the ancillary and facility PPO network contracts, including contracting and rate negotiation functions. This role requires strong negotiation skills, an understanding of healthcare contracting and compliance and the ability to foster and manage relationships to improve network efficiency and access for clients.

Requirements

Minimum of five years' experience in health care; including a minimum of three years in provider/payor contracting.
Candidates must have knowledge of the hospital, ancillary and physician communities and experience interacting with providers in practice or a managed care organization.
Must have knowledge of provider recruitment and contracting, and reimbursement methodologies for providers, ancillaries and hospitals.
Must have excellent verbal, written and organizational skills, working knowledge of MS Outlook, Word, Excel, and a valid driver’s license.
Must be self-motivating and have the ability to work independently and within a team.
Bachelor’s degree in health care administration, business or an equivalent combination of education and work experience in managed care or health care required.

Responsibilities

In conjunction with Network Operations Management, develops strategy for network expansion and maintenance through analysis and market knowledge to ensure the network is adequate, cost-effective and meets strategic goals
Identifies network needs in both new and existing service areas, investigate options, targets and recruits
Initiate contact with potential facilities/ancillary providers. Obtain information necessary to determine quality and rate appropriateness for addition to the network
Assist Appeals department by acting as liaison between ancillary/facility and appeal department to achieve favorable outcomes of member related issues, complaints, reimbursement or other billing issues. Determines root cause of issues, corrects and educates provider and/or staff
Represents CHN PPO externally delivering a professional and polished image and demonstrates professional and ethical business practices
Visits/meets with ancillaries/facilities regularly to educate and establish effective working relationships
Negotiate rates and contract language for overall execution
Negotiate payment and secure single case agreements for ancillary/facility bills as needed and for pre‑treatment services upon request from clinical staff
Assist with facilitating the credentialing and recredentialing process for each facility/ancillary provider
Renegotiate/renew existing contracts using analysis of cost and utilization data, gaps in service and quality reports to ensure network adequacy at efficient pricing
Assist with the development of Request for Proposals, contract updates, new product implementation and new reimbursement methodologies
Assist in preparation of updating Provider/Facility Manual
Supports the activities of the Client Services and Sales teams - attend client meetings as necessary to discuss PPO strategy, philosophy and education