Provider Contracting Manager jobs in Illinois

Provider Contracting Manager manages the activities of the contracting staff that prepare and maintain contracts and the contracts database system for a health plan network. Responsible for negotiating with facilities joining the health network and setting rates. Being a Provider Contracting Manager oversees network reporting requirements to ensure compliance with regulatory agencies, and to produce accurate and relevant reporting of data. Trains and develops staff. Additionally, Provider Contracting Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Provider Contracting Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Provider Contracting Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Manager Payor Provider Contracting Managed Care
  • USA Clinics Group
  • Lincolnshire, IL CONTRACTOR,FULL_TIME
  • The Manager Payor Provider Contracting Managed Care will provide strategic direction for and oversight of all managed care network development activities, oversee negotiation of all managed care contracting activities for fee-for-service (FFS) agreements, and leading and directing strategic activities associated with negotiating, implementing, and maintaining complex managed care contracts and relationships with third party risk bearing entities (i.e. payers and providers). Achieving this by working collaboratively with Revenue Management and Information Services departments to address operations, utilization and reimbursement issues Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout the contract life cycle.

    Only candidates who can reliably commute to the position's location in Northbrook, Illinois will be considered.

    Responsibilities

    Oversees the negotiation of all managed care contracting activities including but not limited to:

    All for fee-for-service (FFS) agreements

    All "ad-hoc" individual case agreements in accordance with policies and standards.

    Negotiating complex managed care contracts and securing optimal reimbursement rates that maximize utilization and increase value.

    Lead and Direct all strategic activities associated with negotiating, implementing, and maintaining complex managed care contracts and relationships with third party entities.

    Work within an evolving business line to coordinate contract negotiation, implementation, and administration for Client's new healthcare services and solutions.

    Monitor and analyze performance of third-party payer agreements including profitability, volume, strategic initiatives and payer/provider compliance issues Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations in regard to Managed Care contracts

    Achieve and maintain a full understanding of Medicare and or Medicaid pricing reimbursement and structure for both Payors & providers.

    Partner with the management team to identify, develop, and implement appropriate approaches, processes, and tools that elevate the analytics group.

    Lead the implementation of managed care contracts with internal departments to develop and maintain systems to disseminate contract information.

    Lead and manage the contract terms and commitments to assure all deliverables are adhered to and take proactive measures before key milestones are missed.

    Work with corporate and field on any reimbursement issues and brings exceptions or non-standard requests to the attention of senior management where appropriate.

    Maintain communication regarding third party participation, contract compliance, and any other operational issues or opportunities.

    Review Third Party medical adherence Contracts to ensure operational requirements can be met and implemented.

    Negotiate, analyze and model current, proposed, and final pricing terms for payors in accordance with pricing standards.

    Lead the development and implementation of an annual strategic plan for third party payer contracting, including the continued development of opportunities and implementation of pricing strategies and contract language standards.

    Monitor the technical links between the Third-Party Provider and data tracking systems to assure reported issues are properly captured, reported, prioritized and managed to closure.

    Work with appropriate internal and external parties to load and update new/existing location, market, and provider information.

    Manage and audit the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate profit and reimbursement.

    Perform additional duties as assigned.

    Requirements

    Bachelor's degree, required

    5 years in a similar role, required.

    5 years monitoring and analyzing performance of third-party payer agreements including profitability, volume, strategic initiates, and payer/provider compliance issues, required

    Ability to work within an evolving business line to coordinate contract negotiation, implementation, and administration for Client's new healthcare services and solutions.

    Expertise in managed care contracts of healthcare services, and their respective business issues and potential opportunities.

    Benefits

    Health

    Dental

    Vision

    401K & Company Match

    PTO

  • 9 Days Ago

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Senior Manager Payor Provider Contracting Managed Care@ Chicago, IL (Chicago, IL)
  • CEDENT
  • Chicago, IL FULL_TIME
  • Title: Senior Manager Payor Provider Contracting Managed Care@ Chicago, IL Terms of Hire: Full time. Salary: $ 140,000–$148,000 / YR Benefits Job description Provide strategic direction for and oversi...
  • 1 Month Ago

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Product and Contracting Manager
  • ABERCROMBIE & KENT USA LLC
  • Downers Grove, IL FULL_TIME
  • Position SummaryAs the Product and Contracting Manager for the USA & Canada DMC, you will oversee all facets of product development and contracting. This includes spearheading product and destination ...
  • 9 Days Ago

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Direct Contracting Manager - Chicago Area
  • TriWest Healthcare Alliance
  • Chicago, IL FULL_TIME
  • Profile Veterans, Reservists, Guardsmen and military family members are encouraged to apply!! We offer remote work opportunities (AK, AR, AZ, *CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, N...
  • 2 Days Ago

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Project Manager - Job Order Contracting (JOC) - Chicago
  • Michael Page
  • Chicago, IL FULL_TIME
  • About Our Client This firm does an average of $50M a year and has been around for over 50 years. This contractor does work across a couple different states and they're looking for someone to add to th...
  • 14 Days Ago

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Project Manager/Estimator
  • Johnson Contracting Company
  • East Moline, IL FULL_TIME
  • Johnson Contracting Company, an established successful company located in East Moline, IL, is seeking an experienced Industrial Project Estimator/Project Manager to estimate, coordinate, and manage in...
  • 12 Days Ago

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Phoenix, AZ
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Los Angeles, CA
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Irvine, CA
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Nashville, TN
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Chicago, IL
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contracting Manager
  • Health New England
  • SUMMARY: The Provider Contracting Manager is responsible for leading or assisting with network development activities of...
  • 4/23/2024 12:00:00 AM

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Provider Contract Management Specialist
  • Cambia Health Solutions Inc
  • Portland, OR
  • Provider Contract Management Specialist Remote opportunity for residents of OR, WA, ID and UT Primary Job Purpose The Pr...
  • 4/23/2024 12:00:00 AM

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Provider Contract Management Specialist
  • Cambia Health Solutions, Inc
  • Portland, OR
  • Provider Contract Management Specialist Remote opportunity for residents of OR, WA, ID and UT Primary Job Purpose The Pr...
  • 4/22/2024 12:00:00 AM

Illinois (/ˌɪlɪˈnɔɪ/ (listen) IL-ih-NOY) is a state in the Midwestern and Great Lakes region of the United States. It has the fifth largest gross domestic product (GDP), the sixth largest population, and the 25th largest land area of all U.S. states. Illinois is often noted as a microcosm of the entire United States. With Chicago in northeastern Illinois, small industrial cities and immense agricultural productivity in the north and center of the state, and natural resources such as coal, timber, and petroleum in the south, Illinois has a diverse economic base, and is a major transportation hu...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Manager jobs
$111,687 to $148,321

Provider Contracting Manager in Gastonia, NC
By simplifying and automating the provider contracting lifecycle, we help make it easier for health plans to identify and implement savings opportunities to obtain maximum value from provider relationships.
January 09, 2020
Provider Contracting Manager in Springfield, IL
Responsible for the oversight of their assigned networks to ensure network provider deficiencies are being met and working closely with their assigned Network Support staff and Medical Management counterparts to ensure network needs/changes are being effectively addressed and communicated both internally and externally.
January 19, 2020
Provider Contracting Manager in Cedar Rapids, IA
New care delivery models, complex regulations and narrowing provider networks have significantly altered the provider contract management process.
February 03, 2020