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Provider Contract Manager

Company: Alignment Healthcare
Location: Bloomington
Posted on: January 12, 2022

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.

  • Work 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.Essential Physical Functions: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 Jobble

Keywords: Alignment Healthcare, Bloomington , Provider Contract Manager, Executive , Bloomington, Illinois

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