Provider Contracting Director jobs in Pennsylvania

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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Manager, Provider Contracting Operations
  • Health Partner Plans, Inc.
  • Pittsburgh, PA FULL_TIME
  • Why Choose Jefferson Health Plans?
    We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
    While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

    Perks of JHP and why you will love it here:
    • Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
    • Flextime and Work-at-Home Options
    • Benefits & Wellness Program including generous Time Off
    • Impact on the communities we service
    We are hiring a Manager, Provider Contracting Operations to join our team remotely!

    The Manager, Provider Contracting Operations oversees the Provider Contracting team operations, data and workflows. The Manager is responsible for managing the provider contracting end-to-end processes, which include the contract execution process, updates to the provider data systems, and tracking tools for all JHP contracts. In addition, the Manager creates and updates the department’s operating procedures and workflows. Finally, the Manager maintains and as required, updates the corporate provider contracting templates for all provider types.

    As the Manager, Provider Contracting Operations, your daily duties may include...
    • Manage the Contract Operations team and processes, including tracking and monitoring standard and nonstandard contracts as they go through execution and implementation.
    • Ensure that contract data and information are stored in the JHP contract management system.
    • Manage the development and content of the hospital, professional and ancillary provider contract templates. Work closely with contracting, legal, and other stakeholders to ensure that all terms and revisions meet legal and regulatory requirements.
    • Align and modify provider contracting templates to support JHP’s mission and business strategies.
    • Manage contract renewal calendar and key event (e.g., increases, contract terms, unique provisions) tracking system.
    • Develop and oversee departmental workflows and policies and procedures. Modify processes as needed.
    • Update contract management system with information and data from executed provider contracts.
    • Support network adequacy analytics with data and information from the contract management system.
    • Perform job duties in compliance with policies and procedures of Jefferson Health Plans.
    • Additional duties as assigned.
    Qualifications and Skills, we value
    • Bachelor’s Degree or six years’ relevant experience
    • 3-5 years of experience in a managed care or healthcare setting (payer or provider based), with experience in physician, ancillary and hospital contracting, healthcare or payer operations, provider recruitment, and/or claims payment.
    • Preferred experience in management and/or leadership.
    • Prior experience with a government programs health plan preferred, but not required.
    Skills/Abilities:
    • Superior verbal and written communication skills
    • Strong negotiation, conflict resolution, organization, project management skills.
    • Strong quantitative analytic abilities.
    • Careful attention to detail.
    • Ability to represent Health Partners Plans independently with external providers and senior level hospital and health system executives.
    • Intermediate to advanced use of Microsoft Excel and Word, knowledge of current health care industry and knowledge of governmental program hospital/provider payment methodologies, sufficient to analyze cost and operational impact.
    • Familiarity with claims payments processes and systems.
  • 8 Days Ago

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Manager, Provider Contracting Operations
  • Health Partner Plans, Inc.
  • Harrisburg, PA FULL_TIME
  • Why Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that includ...
  • 9 Days Ago

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Provider Contracting Specialist
  • Wexford Health
  • Pittsburgh, PA FULL_TIME
  • To Apply for this Job Click Here POSITION: Provider Contracting Specialist SCHEDULE: Full-Time (Monday-Friday 8:30AM – 5PM) FACILITY: Wexford Health Sources, Inc. Corporate Office LOCATION: Green Tree...
  • 13 Days Ago

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Senior Provider Contracting Manager
  • FourStone Partners
  • West Chester, PA FULL_TIME
  • FourStone Partners is an innovative consulting firm specializing in business development, sales outsourcing, and operational support services within the Workers' Compensation industry. FourStone Partn...
  • 28 Days Ago

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Provider Network Development and Contracting Representative
  • FourStone Partners
  • West Chester, PA FULL_TIME
  • FourStone Partners is an innovative consulting firm specializing in business development, sales outsourcing, and operational support services within the Workers' Compensation industry. FourStone Partn...
  • 2 Days Ago

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Director of Contracting and Payer Relations
  • Pennsylvania Mountains Healthcare Alliance (PMHA)
  • Du Bois, PA FULL_TIME
  • Director of Contracting and Payer Relations Pennsylvania Mountains Healthcare Alliance (PMHA) is seeking a Director of Contracting and Payer Relations. The position is a key strategic role in the mana...
  • 24 Days Ago

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Licensed/Provisionally Licensed Therapist
  • Lutheran Family and Children's Services of Missouri
  • Saint Louis, MO
  • Lutheran Family and Children's Services of Missouri is expanding our Behavioral Health services into Springfield, MO! Be...
  • 4/25/2024 12:00:00 AM

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Construction plans Examiner - Provisional
  • Palm Beach County, FL
  • Palm Beach, FL
  • Examines construction plans for compliance with Florida Building Code, Florida Statutes and County regulations. Reviews ...
  • 4/24/2024 12:00:00 AM

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Provisional Licensed Counselor
  • Christian Wellness Center Of NJ LLC
  • Somerset, NJ
  • Job Description Job Description Duties/Responsibilities: • Provide counseling for clients and patients, individually and...
  • 4/23/2024 12:00:00 AM

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Licensed Psychotherapist ( Provisional or Fully Licensed)
  • Clinical Counseling and Consulting
  • Fayetteville, NC
  • Job Description Job Description We are seeking a Licensed Psychotherapist ( Provisional Or Fully Licensed) to join our t...
  • 4/23/2024 12:00:00 AM

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Provisionally Licensed / Associate Level Therapist
  • Destination Therapy
  • Houston, TX
  • Destination Therapy is an Equal Opportunity Employer. We are committed to a diverse workforce that reflects the populati...
  • 4/22/2024 12:00:00 AM

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Thermostat Repairer- Provisional
  • CUNY
  • Bronx, NY
  • Thermostat Repairer- Provisional Job ID 28288 Location Bronx Community College Full/Part Time Full-Time Regular/Temporar...
  • 4/22/2024 12:00:00 AM

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Clinical Provider
  • Burrell Behavioral Health
  • Springfield, MO
  • Job Description: CLINICAL PROVIDER What you'll get to do: Provide individual, group, family and/or other practical couns...
  • 4/22/2024 12:00:00 AM

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Provisionally Licensed / Associate Level Therapist
  • Destination Therapy
  • Houston, TX
  • Destination Therapy is an Equal Opportunity Employer.We are committed to a diverse workforce that reflects the populatio...
  • 4/21/2024 12:00:00 AM

Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east. Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Director jobs
$172,171 to $248,660

Provider Contracting Director in New Suffolk, NY
The partners expect that their efforts toward greater collaboration between mutuelles and private providers will contribute to greater financial risk protection of covered citizens and support access to universal health coverage.
January 02, 2020
Provider Contracting Director in Vincennes, IN
The provider of services can choose how to perform the service.
January 27, 2020
Provider Contracting Director in Wichita Falls, TX
The Credentialing Committee is chaired by our Medical Director and they give the final determination if a provider meets our credentialing criteria.
December 05, 2019