First Choice Health
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Provider Network Contract Manager
role at
First Choice Health .
Base pay range $90,000.00/yr - $120,000.00/yr
Candidates should reside in Tennessee or Kentucky.
POSITION SUMMARY: The Provider Network Contracting Manager is responsible for contracting relationships with physicians, physician groups, hospitals, ambulatory surgery centers, and ancillary providers. Responsibilities include developing contracting strategies, analytical support, negotiation, and administration. The role involves cultivating relationships with high-quality providers and pursuing cost-effective reimbursement strategies.
EXAMPLES OF DUTIES:
Negotiate and maintain contracts with providers.
Develop and implement contracting strategies to expand and improve the provider network.
Evaluate provider networks to meet adequacy standards.
Analyze financial, quality, and utilization data to inform contracting strategies.
Ensure regulatory compliance of contracts.
Educate internal teams on provider contracts and payment methodologies.
Participate in special projects and initiatives as assigned.
Collaborate with other departments to define and review business requirements.
QUALIFICATIONS:
BA/BS degree preferred or equivalent work experience.
5+ years in the insurance industry, focusing on contracting, provider outreach, or claims processing.
Knowledge of provider contracts, reimbursement methodologies, and pricing issues.
Proficiency with spreadsheets, databases, and reporting systems like MS Excel, Salesforce, or MS Access.
Understanding of medical coding (ICD-10, CPT, HCPCS).
Strong communication, analytical, and organizational skills.
PHYSICAL REQUIREMENTS:
Normal hand and finger dexterity.
Ability to stand, bend, lift up to 10 lbs, and sit for extended periods.
Normal vision and hearing, with or without aids.
Access to PHI: Routine contact with limited PHI that does not require manager approval, such as claims adjudication.
ABOUT FIRST CHOICE HEALTH: First Choice Health is a provider-owned healthcare organization based in Seattle, WA, serving employers with innovative health benefits, including clinically integrated networks and PPO plans, for over 35 years.
OUR VALUES & CULTURE: We focus on transparency, collaboration, and innovation, fostering a culture of belonging and diversity to serve our communities better.
BENEFITS:
Medical, vision, and dental plans.
Health Savings Account (HSA) and Flexible Spending Account (FSA).
Life insurance, disability benefits, paid time off, holidays, and Employee Assistance Program.
Retirement plans including 401(k) with company contributions, profit sharing, and tuition reimbursement.
Wellness programs and other employee support benefits.
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Provider Network Contract Manager
role at
First Choice Health .
Base pay range $90,000.00/yr - $120,000.00/yr
Candidates should reside in Tennessee or Kentucky.
POSITION SUMMARY: The Provider Network Contracting Manager is responsible for contracting relationships with physicians, physician groups, hospitals, ambulatory surgery centers, and ancillary providers. Responsibilities include developing contracting strategies, analytical support, negotiation, and administration. The role involves cultivating relationships with high-quality providers and pursuing cost-effective reimbursement strategies.
EXAMPLES OF DUTIES:
Negotiate and maintain contracts with providers.
Develop and implement contracting strategies to expand and improve the provider network.
Evaluate provider networks to meet adequacy standards.
Analyze financial, quality, and utilization data to inform contracting strategies.
Ensure regulatory compliance of contracts.
Educate internal teams on provider contracts and payment methodologies.
Participate in special projects and initiatives as assigned.
Collaborate with other departments to define and review business requirements.
QUALIFICATIONS:
BA/BS degree preferred or equivalent work experience.
5+ years in the insurance industry, focusing on contracting, provider outreach, or claims processing.
Knowledge of provider contracts, reimbursement methodologies, and pricing issues.
Proficiency with spreadsheets, databases, and reporting systems like MS Excel, Salesforce, or MS Access.
Understanding of medical coding (ICD-10, CPT, HCPCS).
Strong communication, analytical, and organizational skills.
PHYSICAL REQUIREMENTS:
Normal hand and finger dexterity.
Ability to stand, bend, lift up to 10 lbs, and sit for extended periods.
Normal vision and hearing, with or without aids.
Access to PHI: Routine contact with limited PHI that does not require manager approval, such as claims adjudication.
ABOUT FIRST CHOICE HEALTH: First Choice Health is a provider-owned healthcare organization based in Seattle, WA, serving employers with innovative health benefits, including clinically integrated networks and PPO plans, for over 35 years.
OUR VALUES & CULTURE: We focus on transparency, collaboration, and innovation, fostering a culture of belonging and diversity to serve our communities better.
BENEFITS:
Medical, vision, and dental plans.
Health Savings Account (HSA) and Flexible Spending Account (FSA).
Life insurance, disability benefits, paid time off, holidays, and Employee Assistance Program.
Retirement plans including 401(k) with company contributions, profit sharing, and tuition reimbursement.
Wellness programs and other employee support benefits.
#J-18808-Ljbffr