Contracting Systems Manager - Health Plan
About The Position
The Contracting Systems Manager serves as the contracting subject matter expert responsible for ensuring provider contract intent is accurately translated into system configuration and operational outcomes. Acting as the primary Contracting representative for QNXT, contract management systems, and related enterprise implementations, this role provides oversight of contract-to-configuration alignment, testing validation, discrepancy resolution, and implementation readiness to reduce financial, operational, and provider disruption risk. This position partners closely with Configuration, Claims, IT, Network Management, Provider Operations, Finance, and implementation teams to ensure provider contract requirements are accurately operationalized and sustained throughout the contract lifecycle, including new agreements, renewals, amendments, and system enhancement initiatives.
Requirements
- Bachelor's degree or equivalent experience in Healthcare Administration, Business Administration, Finance, Information Systems, Public Health, or related field
- 5+ years of experience in managed care, provider contracting, network management, claims operations, configuration support, healthcare systems implementation, or related healthcare or health insurance plan operations.
- Experience interpreting and applying complex provider contract terms, reimbursement methodologies, and payment arrangements.
- Experience participating in large-scale operational or technology implementations.
- Experience collaborating across multiple business functions, including Contracting, Claims, Configuration, Operations, Network Management, Finance, and Information Technology.
- Experience supporting testing, validation, issue resolution, implementation readiness, and production support activities for business-critical systems.
- Strong analytical experience identifying operational, financial, payment, and implementation risks and developing recommendations for resolution.
- Microsoft Office (Word, Excel, PowerPoint, Teams, Outlook) at advanced skill level.
Nice To Haves
- Experience with QNXT or other healthcare claims administration platforms.
- Experience supporting Contract Lifecycle Management systems or contract repository solutions.
- Experience with user acceptance testing, parallel testing, payment validation, and production readiness activities.
- Knowledge of provider configuration, claims adjudication, fee schedules, value-based reimbursement models, delegated risk arrangements, and Medicare Advantage operations.
- Experience supporting enterprise transformation initiatives, system conversions, or business process redesign efforts.
- Experience facilitating discussions between technical, operational, and business stakeholders.
- Experience developing implementation standards, quality controls, workflows, and operational procedures.
- Project management or process improvement experience preferred.
Responsibilities
- Serve as the Contracting subject matter expert for QNXT, contract management system, and other enterprise system implementations.
- Provide oversight and validation of contract-to-configuration alignment to ensure provider agreements are accurately operationalized.
- Review complex reimbursement methodologies and contract provisions to identify risks associated with system configuration and claims adjudication.
- Lead contract-related testing activities including UAT, parallel testing, payment validation, and go-live readiness assessments.
- Identify, investigate, and escalate discrepancies between contract intent and system outcomes.
- Partner with Configuration, Claims, IT, Provider Operations, and implementation teams to develop solutions for contract implementation issues.
- Establish and maintain processes and controls that support ongoing contract-to-system accuracy.
- Serve as the primary business resource for contract implementation, renewals, amendments, and system enhancement initiatives.
- Analyze operational and financial impacts of contract implementation decisions and provide recommendations to leadership.
- Lead special projects and process improvement initiatives supporting enterprise contracting and payment accuracy objectives.
- Actively support the achievement of SCAN’s Vision and Goals.
- Other duties as assigned.
Benefits
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
