Provider Contracting Manager jobs in Pennsylvania

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, 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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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 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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Practice Manager - Dental Site
  • Provider Openings
  • Rochester, PA FULL_TIME
  • Position Overview The Practice Manager I will be responsible for supervision of our Rochester Dental site and will effectively carry out the Network’s Policies and Procedures while communicating manag...
  • 6 Days Ago

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Practice Manager - Dental Site
  • Provider Openings
  • Rochester, PA FULL_TIME
  • Position Overview The Practice Manager I will be responsible for supervision of our Rochester Dental site and will effectively carry out the Network’s Policies and Procedures while communicating manag...
  • 6 Days Ago

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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 Manager *REMOTE Seattle Area*
  • Dexian
  • Seattle, WA
  • Position: Provider Contract Manager *REMOTE Seattle Area* Location: Remote - Everett, Seattle, Tacoma, Washington State ...
  • 4/22/2024 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

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Provider Contracts Manager
  • Molina Healthcare
  • New York, NY
  • ***Remote and must live in New York*** Job Description Job Summary Molina Health Plan Provider Network Contracting jobs ...
  • 4/22/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Atlanta, GA
  • Position: Provider Contract Manager *REMOTE Seattle Area* Location: Remote - Everett, Seattle, Tacoma, Washington State ...
  • 4/22/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Columbus, OH
  • Position: Provider Contract Manager *REMOTE Seattle Area* Location: Remote - Everett, Seattle, Tacoma, Washington State ...
  • 4/22/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • San Jose, CA
  • Position: Provider Contract Manager *REMOTE Seattle Area* Location: Remote - Everett, Seattle, Tacoma, Washington State ...
  • 4/22/2024 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 Manager jobs
$108,958 to $144,696

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