Provider Network Coordinator
3 days ago
Our company is committed to providing exceptional patient care and improving the health outcomes of our communities. We are a dynamic and growing organization that values innovation, collaboration, and excellence.
Job DescriptionThis is an exciting opportunity for a skilled Contracts Manager to join our team. The successful candidate will be responsible for managing provider network contracts, health networks, professional, ancillary, and facility providers.
The ideal candidate will have a strong background in provider contracting, negotiation, hospital, and delegated health network/medical group provider agreements or other complex provider contracts. Experience with Medi-Cal and Medicare lines of business within a health plan or large healthcare delivery system is also essential.
Key Responsibilities- Negotiate and manage provider network contracts, health networks, professional, ancillary, and facility providers as assigned.
- Maintain and report the status of Letters of Agreement (LOA) dispositions, develop action plans to transition non-contracted providers to full contracts when possible, and collaborate with other staff to monitor and expedite the credentialing/contracting process.
- Optimize and maintain accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
- Manage project plans when implementing network-wide contract initiatives and coordinate with legal, medical management, provider relations, finance, and OneCare sales and marketing to implement new and renewing provider contracts.
- Monitor performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models, and financial risk sharing through contractual arrangements.
- Bachelor's degree plus 4 years of experience in provider contracting, negotiation, hospital, and delegated health network/medical group provider agreements or other complex provider contracts.
- Experience with Medi-Cal and Medicare lines of business within a health plan or large healthcare delivery system.
- Strong analytical, problem-solving, and project management skills.
- Ability to work independently and exercise sound judgment.
- Excellent communication and interpersonal skills.
We offer a competitive salary of $43.66 - $69.86 per hour, a comprehensive benefits package, and opportunities for career growth and development.
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