Provider Contract Manager
Company: Alignment Healthcare
Location: Bloomington
Posted on: January 12, 2022
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Job Description:
**This is an individual contributor role. Must have experience
in contract negotiations, redlining and drafting.**
Alignment Healthcare was founded with a mission to revolutionize
health care with a serving heart culture. Through its unique
integrated care delivery models, deep physician partnerships and
use of proprietary technologies, Alignment is committed to
transforming health care one person at a time.By becoming a part of
the Alignment Healthcare team, you will provide members with the
quality of care they truly need and deserve. We believe that great
work comes from people who are inspired to be their best. We have
built a team of talented and experienced people who are passionate
about transforming the lives of the seniors we serve. In this
fast-growing company, you will find ample room for growth and
innovation alongside the Alignment community.Position
Summary:Alignment Healthcare is seeking a network management
specialist to assist with building and maintaining high-performance
provider networks by identifying opportunities to grow membership,
contract with providers, and improve the contractual performance.
As a network management specialist, you will work closely with
other departments to enhance the contracted provider experience
consistent with the company mission statement and values.
General Duties/Responsibilities (May include but are not limited
to): Responsible for the negotiation of cost effective primary care
and specialty care physician, and ancillary contracts, and
maintenance of AHP networks on an ongoing basis and as requested by
the Regional Markets
Provide direct physician and ancillary contracting guidance and
function as the subject matter expert in direct physician and
ancillary contacting for all Markets
Act as the technical resource on provider relations issues related
to physician and ancillary contracts. Responsible for timely and
professional interaction with internal and external customers.
As requested, assist with the negotiation of provider letters of
agreements.
Enhances the relationship with providers by providing, appropriate
data sharing, by efficiently and effectively responding to requests
for information, and by successfully resolving issues related to
capitation, claims, and other operational functions.
Utilizes understanding of the business risk relationships to
interact and influence primary care and specialty care physicians,
and ancillary provdiers and identify key types of contracts that
need to be negotiated.
Maintains timely internal awareness of network changes by issuing
timely and accurate provider update communications about
contractual arrangement changes, provider terminations, changes and
additions.
Ensures overall compliance by responding to grievances/appeals and
adhering to regulatory and departmental Policy and Procedure
guidelines and timeframes.
Maintains up-to-date, accurate provider database by overseeing
proofing effort, prompt processing of terminations.
Contribute to team effort by accomplishing related results as
needed.
Other duties as assignedSupervisory Responsibilities:N/A
Minimum Requirements:To perform this job successfully, an
individual must be able to perform each essential duty
satisfactorily. The requirements listed below are representative of
the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions.
Minimum Experience:o Minimum 5 years experience in provider
relations / contracting with an HMO or IPA, medical group or
institutional provider required Education/Licensure:o Bachelors
Degree preferred. Other:o Strong analytic, quantitative, and
problem-solving skills required.o Strong verbal and written
communication skills required.o Strong presentation skills and
ability to appropriately and effectively address diverse audiences
required.o Proficiency in MS Word and Excel required; Access
database proficiency preferred.o Work Conditions:i. Office Hours:
Monday-Friday, 8am to 5pm. Extended work hours, as needed.ii.
20-60% or more travel by car routinely required for
Specialists.iii. Travel by plan required as needed to support
provider services needs in other geographies.iv. Maintain reliable
means of transportation. If driving, must have a valid drivers
license and automobile insurance.
Keywords: Alignment Healthcare, Bloomington , Provider Contract Manager, Executive , Bloomington, Illinois
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