Provider Contract Specialist Manager

CareBridge-posted 3 months ago
Full-time • Mid Level
Mason, OH
251-500 employees
Ambulatory Health Care Services
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The Provider Contract Specialist Manager functions with the expertise in managing negotiated pricing loads. Responsible for coordinating the process for the most complex pricing arrangements involving facilities or large health systems, or high profile provider groups and/or physician groups tied to large hospital systems joining the network including creating standard contracts for providers as needed.

  • Manage provider update files submitted by delegated provider entities and/or large groups/integrated delivery system.
  • Prepare the information for timely and accurate submission to the Provider Data Management area.
  • Ensure updates/changes for existing network providers are interpreted and loaded accurately.
  • Ensure accurate and timely loading of professional and facility contracts across value based and fee for service agreements for provider solutions.
  • Work directly with contracting directors and managers to understand what is negotiated and how the negotiated agreement is translated into the company's systems resulting in accurate and timely loading.
  • Perform internal audit of provider record, ensuring accuracy against rosters.
  • Serve as the go-to with matrix partners to resolve interpretation issues and ensure timely turnaround.
  • Serve as local market expert supporting (and managing when necessary) the provider onboarding process and provider updates submitted by provider offices within defined market.
  • Requires a H.S. diploma or equivalent and a minimum of 5 years of experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background.
  • Use a centralized system or database to manage and store provider and system data.
  • Implement automated processes for updating provider information, such as credentials, specialties, and contact details, to minimize manual errors.
  • Ensure that data is entered in a standardized format across all systems.
  • Manage the enrollment of providers into insurance plans, ensuring they meet all necessary requirements and regulatory guidelines followed.
  • Merit increases
  • Paid holidays
  • Paid Time Off
  • Incentive bonus programs
  • Medical benefits
  • Dental benefits
  • Vision benefits
  • Short and long term disability benefits
  • 401(k) + match
  • Stock purchase plan
  • Life insurance
  • Wellness programs
  • Financial education resources
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