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Work Experience: At least 7 years in healthcare and 3 years in provider contracting, provider relations, or provider network operations required. Position Overview: Oversee provider contracting, provider service, provider partnerships, provider network development, and strategic initiative deployment in assigned territory for PacificSource Health Plans.
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The Regulatory Affairs Associate will be responsible for handling Regulatory Affairs Department activities, including contracts, compliance, surveys, audits, investigations, provider network and relations, and other regulatory compliance matters.
$125,000 - $150,000 a yearFull-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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7-9 years in provider relations, payor contracting, provider enrollment, payor configuration or provider-facility credentialing Required. High School Diploma or GED and 7-10 years of experience in contract management, provider relations or provider enrollment in lieu of bachelor's degree.
$65,190 - $97,785Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Provider Relations Representative works as the primary liaison between Community First Health Plans and network participants (physicians, providers, and administrators) of the health plan provider network.
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12+ years' experience in one of the following areas: population health management, Provider contracting and reimbursement, managed care, healthcare delivery, risk adjustment, Stars. Experience at a provider organization in population health or in provider relations/engagement at a plan.
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These performance expectations will drive the strategy and requirements of numerous operational areas including medical service operations, external provider affiliations and relations, quality and service initiatives, and medical services and provider contracting.
$441,000 - $551,250 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Initiates and perform audits and monitoring activities of various health plan operations, such as appeals and grievances, claims, medical management, customer service, provider relations and contracting, sales and enrollment, and other functions to ensure proper compliance with governmental regulations and health plan policies.
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Provider Relations or Provider Network Contracting experience, or. The end goal is for the provider to sign a Provider Services Agreement to participate in our client's Quality Program.
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The Manager will partner with the Provider Contracting team on initiatives to ensure the EyeMed Provider Agreement and associated fee schedules support the objectives of those initiatives.
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This role will actively partner with multiple areas of the division and broader organization, including Network Economics, Provider Relations, Payment Integrity and Government Network teams, to identify & implement initiatives related to provider network contracting, provider payment, and Wellmark’s sustainability goals.
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The Provider Performance Senior Advisor is an integral part of a cross-functional, collaborative organization (which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment, Finance , Cross-Segment Contracting, Provider Relations, and Network Development & Solutions.
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The Vice President, Payer Relations has enterprise level responsibility for providing strategic and operational leadership in the development and execution of all types of payer contracting programs and provider partnership strategies for all lines of business (including commercial, senior, fee for service and value based.
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At least 3 - 5 years of previous experienced in managed care, health plan operations in provider contracting, provider relations, customer service, coding or claims. Serves in an account management (non-sales) role as the primary business to business liaison between ConnectiCare and its provider network and is responsible for all interactions between the organizations.
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The Provider Engagement Account Manager Sr. reports to the SVP of Provider Relations and Contracting and works very closely with the local IL Market President and leadership team.
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Under general guidance from the Provider Services Manager, the Provider Relations Representative III is responsible for building long-term relationships with physicians, physician groups, ancillary and behavioral health providers and their staff in a positive and proactive manner in order to support their understanding and compliance with Alliance contracts, policies, and procedures.
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