Provider Contracting Director jobs in Morgantown, WV

Provider Contracting Director is responsible for the operations of the provider contracts department. Ensures that provider contracts are processed to support accurate and efficient claims payments. Being a Provider Contracting Director oversees the formulation of provider contracts and specific terms. Analyzes contract data and provides financial projections. Additionally, Provider Contracting Director requires a bachelor's degree. Typically reports to top management. The Provider Contracting Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Provider Contracting Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

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Network Provider Contracting Specialist - Peak Health
  • Allied Health Solutions
  • Morgantown, WV FULL_TIME
  • Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position.

    Plays a critical role in developing a network for our members and providers. Reporting to the Manager of Contracting you will be a critical part of the Provider Relations team.

    The ideal candidate for this role is a passionate, community oriented and has direct health plan managed care contracting experience. You have strength in negotiating complex contacts, evaluating competing priorities while staying aligned with organizational goals and strategies. You are technically savvy with a solid understanding of network adequacy requirements and health plan analytics to aid in the contracting process. You are flexible and thrive in a fast-paced, environment.

    The Contracting Specialist is responsible for analyzing contracts between Peak Health and its network providers for the various Peak Health products. Analyze data from various sources and systems for both physician and hospital services in order to present reports to key management and staff and to recommend and implement solutions to assist in the contracting decision-making process.

    MINIMUM QUALIFICATIONS:

    EDUCATION, CERTIFICATION, AND/OR LICENSURE:

    1. Bachelor's degree in Business Administration, Health Care Management OR High School Diploma and equivalent work experience.

    EXPERIENCE:

    1. One (1) year of work experience in healthcare data analytics, healthcare consulting analytics or healthcare contracting analytics.

    2. One (1) year of related healthcare insurance experience in related contractual, financial or provider related activities with major healthcare insurance companies.

    PREFERREDQUALIFICATIONS:

    EDUCATION, CERTIFICATION, AND/OR LICENSURE:

    1. Direct experience in data analysis, financial analysis and reporting to include proficient extracting information from various payer systems; utilizing information obtained in most applicable manner; and developing complex mathematical models

    2. Progressive experience in health care management, physician groups, hospitals, payer contract negotiations, legal reviews of contract, or contact management preferred.

    3. Consulting and/or healthcare decision support work experience in the healthcare industry preferred.

    CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

    1. Conducts negotiations with hospitals, physicians and ancillary providers on behalf of Peak Health.

    2. Presents healthcare data in a meaningful, concise and beneficial manner to upper management.

    3. Utilizes data to provide consulting service and decision support on healthcare topics critical to health plan system wide decisions for upper management.

    4. Develops and maintains tracking system for reimbursement and statistical information. Ensures data integrity and accuracy.

    5. Summarizes offers for review with appropriate Peak Health committees and individuals.

    6. Communicates the implementation of new and renewal contracts to upper management and monitors the reimbursement to ensure accurate payment of claims by Peak Health.

    7. Audits large volumes of data and conducts in-depth quantitative analysis of results and evaluates trends.

    8. Communicates and educates other regarding financial improvement analysis, findings and recommendations.

    9. Maintains contract files for Peak Health.

    10. Maintains physician fee and hospital rate information for Peak Health contracted providers.

    11. Maintains contract information on major providers with selected competitor and benchmark providers.

    12. Organizes meeting materials and attends various organization meetings as needed as well as assists in development of annual strategic planning.

    13. Works with providers to resolve provider billing, denial, and appeal issues and explores hassle reduction improvements to incorporate into new and existing contracts.

    14. Must remain current with how information is collected, maintained and reported in all key systems.

    15. Participates in meeting the objectives of the work unit and goal of the department.

    PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    1. Standard office environment.

    SKILLS AND ABILITIES:

    1. Thorough understanding of healthcare regulations.

    2. Ability to perform contract modeling.

    3. Understanding of healthcare reimbursement payment methodologies.

    4. Strong problem solving and quantitative abilities.

    5. Excellent communication and collaboration skills.

    6.Attention to detail.

    Additional Job Description:

    insurance/health plan

    remote

    Scheduled Weekly Hours:

    40

    Shift:

    Exempt/Non-Exempt:

    United States of America (Exempt)

    Company:

    PHH Peak Health Holdings

    Cost Center:

    2901 PHH Provider Management
    Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

    The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

     

  • 19 Days Ago

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Carpenter/Laborer
  • KBR Contracting
  • Clarksburg, WV FULL_TIME
  • Overview: We are seeking a skilled Carpenter/Laborer to join our team. As a Carpenter/Laborer, you will be responsible for various tasks related to construction and general labor. Responsibilities: - ...
  • 1 Day Ago

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Satellite Technician
  • livewire contracting
  • Wheeling, WV FULL_TIME
  • Are you looking for a new or different career path? Now Hiring Entry Level Satellite Technicians!! Want to learn a new Skill/Trade? Pay Range is $750.00-$1200.00 per week for entry level positions wit...
  • 1 Month Ago

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(Hybrid) Category Analyst - Procurement, Contracting & Payment Services
  • West Virginia University
  • Morgantown, WV FULL_TIME
  • Description The department of Procurement, Contracting and Payment Services at West Virginia University is currently accepting applications for a Category Analyst. About the Opportunity The primary ro...
  • 11 Days Ago

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Concrete Finisher
  • Wolf Creek Contracting
  • Athens, OH FULL_TIME
  • ABOUT THE COMPANY Wolf Creek Contracting is a general contractor serving commercial, industrial, and municipal markets in states across the eastern United States. Services we provide include general c...
  • Just Posted

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Concrete Finisher
  • Wolf Creek Contracting
  • Cambridge, OH FULL_TIME
  • ABOUT THE COMPANY Wolf Creek Contracting is a general contractor serving commercial, industrial, and municipal markets in states across the eastern United States. Services we provide include general c...
  • Just Posted

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0 Provider Contracting Director jobs found in Morgantown, WV area

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Clinical Therapist-Telemedicine/Ambulatory -26166
  • WVU Medicine
  • Morgantown, WV
  • Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the...
  • 3/28/2024 12:00:00 AM

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Morning Stocking Team Member
  • Michaels Stores
  • Morgantown, WV
  • Morning Stocking Team Member page is loaded **Morning Stocking Team Member** **Morning Stocking Team Member** locationsM...
  • 3/28/2024 12:00:00 AM

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Taco Bell - Westover - Team Member
  • Taco Bell - Westover
  • Westover, WV
  • At Taco Bell we're looking for people who love serving customers, have experience in the restaurant industry and who wan...
  • 3/28/2024 12:00:00 AM

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Store Employee
  • 7-Eleven, Inc.
  • Blacksville, WV
  • Overview: Franchisees typically rely on Sales Associates to provide outstanding service, maintain a clean, customer frie...
  • 3/28/2024 12:00:00 AM

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Taco Bell - Patteson - Team Member
  • Taco Bell - Patteson
  • Morgantown, WV
  • At Taco Bell we're looking for people who love serving customers, have experience in the restaurant industry and who wan...
  • 3/27/2024 12:00:00 AM

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Social Services/LMSW (Licensed Masters of Social Worker)
  • Softpath System LLC
  • Clarksburg, WV
  • Shift: Day 5x8-Hour (08:00 - 16:30) Description: IMPORTANT: Fingerprints must be completed in West Virginia at least 7-1...
  • 3/27/2024 12:00:00 AM

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Crew Member
  • Joinfiveguys
  • Morgantown, WV
  • **Crew Member** **COMPANY:** Five Guys Enterprises **REQ #:** 7938481c-1643800872 **LOCATION:** 1026 Suncrest Towne Cent...
  • 3/27/2024 12:00:00 AM

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Team Member
  • GPS Hospitality
  • Morgantown, WV
  • General Information Position: Team Member 7620 Business Unit: Restaurant Brand: Burger King City: Morgantown Restaurant ...
  • 3/27/2024 12:00:00 AM

Morgantown is a city in and the county seat of Monongalia County, West Virginia, United States, situated along the banks of the Monongahela River. It is known as the home of West Virginia University and the Morgantown Personal Rapid Transit (PRT) system. With a permanent population of 31,073 per the 2015 U.S. Census estimates, Morgantown is the largest city in North-Central West Virginia. The Morgantown metropolitan area has a population of 138,176. Morgantown is located 75 miles (121 km) south of Pittsburgh, Pennsylvania, 208 mi (335 km) north-northwest of Washington, D.C., 81 mi (130 km) eas...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Director jobs
$168,509 to $243,374
Morgantown, West Virginia area prices
were up 1.2% from a year ago

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