Posted: 29-May-23
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 10327506
Summary:
The Network Contracting Manager is responsible for negotiating, enhancing and maintaining managed care contracts between US Family Health Plan (USFHP) and CHRISTUS Health Plan (CHP) and physicians, facilities, national providers, and ancillary providers through the USFHP and CHP current and proposed markets. This position works closely with health plan staff who impact operations, including administration, credentialing, finance, information management, provider relations, claims, etc. This position serves as the network contracting point person for the health plans ensuring the accurate, compliant implementation and administration of contracts, processes and procedures. A high degree of professionalism is required due to the interaction with both internal and external contacts.
· Serves as the "point person" to the leadership teams for all managed care contract related aspects, including contract performance, operational issues, negotiation activities, and strategic planning.
· Works with provider relations and claims to investigate and resolve reimbursement issues identified.
· Identifies payment trends and works with leadership including finance and medical management to identify and negotiate improved contracts.
· Carries out appropriate managed care related education and training including roll out of new contracts independently or in partnership with provider relations.
· Assures that new contracts are appropriately reviewed and are rolled out in a timely, accurate manner.
· Assures that new contracts are implemented correctly in the management information systems.
· Routinely validates the correctness and accuracy of the network in the management information system, in the directory and on the web-sites.
· Maintains paper contracts in an organized manner and secures them in a safe environment.
· Assists in payor/plan dispute resolution projects as appropriate.
· Responsible for distribution of managed care related information to appropriate parties within USFHP and CHP.
· Responsible for working closely with the credentialing department to obtain all necessary information at the time of contracting to fully coordinating facility credentialing & re-credentialing activities.
· Develops and prepares required reporting, and meets all state and federal reporting timelines.
· Maintains the ability to produce Geo Access Maps in a timely manner including training of staff in the network or providers relations department.
· Develops department specific metrics, and reports to internal committee including any corrective action plans for identified deficits.
· Educates key associates as to the contracting process/methodology, as needed.
· Maintains and fosters relationships with large, key providers.
· Knowledge of general Federal and applicable State regulatory environment related to managed care and participates in legislative advocacy activities as appropriate.
· Routinely reviews contracts to ensure compliance with State and federal regulations. Ensures proper contract approvals through regulatory bodies.
Requirements:
- Bachelor's Degree required
At least seven (7) years of experience in health care setting and/or insurance organizations with experience in claims resolution, contracting, relationship development and staff education with a medical group or physician setting.
Work Type:
Full Time