Ancillary Contract Manager- Remote in NJ
About The Position
Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve. Summary: 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
