Healthcare Network Manager

3 days ago


Springfield, Massachusetts, United States Health New England Full time
Job Summary

We are seeking an experienced Provider Contracting Specialist to join our team at Health New England. The ideal candidate will have a strong background in contract negotiation, implementation, and maintenance, as well as excellent analytical and communication skills. If you are a motivated and detail-oriented professional looking to make a meaningful contribution to our organization, we encourage you to apply.

Responsibilities
  1. Contract Negotiation (60%):
  • Negotiate contracts with ancillary providers, facilities, and independent physicians in accordance with plan objectives and target budget guidelines
  • Evaluate and monitor network provider adequacy, accessibility, and payment rate parity
  • Makes recommendations for provider network additions/consolidations, vendor additions or changes, or changes in provider payment arrangements
  • Negotiates contracts in accordance with established parameters
  • Coordinates implementation of executed contracts
Analysis and Research (20%):
  • Provides support in the implementation and post-implementation verification of provider contract configuration and payment accuracy
  • Researches and identifies payment discrepancies as a result of HNE system issue(s) and/or provider billing anomalies
  • Assists in performing impact analysis of changes to fees and payment methodologies including comparisons between fixed fee schedules and various other payment arrangements
Department Support (10%): Assist Provider Contracting Department with activities related to the evaluation, implementation, and maintenance of other provider contracts as necessarySpecial Projects (10%): Assist with special projects as necessaryQualifications

A Bachelor's degree with more than 2 years of experience in a managed care environment; clinical experience a plus or an equivalent combination of education and experience. Required skills include knowledge of provider contracting models and arrangements, good knowledge of managed care products, policies, and procedures, effective communication and presentation skills, and strong computer skills, including Microsoft Word, Excel, PowerPoint, and Access.



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