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This position will also coordinate with: Compliance & Quality staff on the re-credentialing process; with Provider Contracting staff for contracting issues or concerns; and will periodically assist the Claims staff with auditing and troubleshooting of provider data to ensure proper claims adjudication.
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Working knowledge of billing/coding terminology (i.e., ICD-10, CPT, Revenue codes); Procedural knowledge of hospital and physician practice accounts receivable managementIn-depth knowledge of payor contracting and negotiationWorking knowledge of privileging, credentialing, provider enrollment and managed care contracting requirements, practices, and industry standards.
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Maintenance of provider enrollment processes and credentialing databases/websites/portals including CAQH, NPPES, Navinet, Availity, PECOS.Support overall Provider Enrollment Department, assist contracting department with requests as necessary and work with RCM to assist with payer issues related to credentialing.
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Minimum Qualifications Master of Public Administration (MPA) or Master of Public Health (MPH) degree required; and 5-7 years of relevant healthcare industry experience in a provider network management and value-based environment; or A satisfactory equivalent combination of education, training, and minimum 10 years of relevant healthcare industry experience in a provider network management and value-based environment.
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8+ years of experience negotiating and drafting commercial agreements (including partnership agreements, managed care service agreements, participating provider agreements, program incentive agreements, provider network agreements revenue/sales contracts, and vendor agreements in the healthcare space.
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Experience working in healthcare provider analytics related to revenue modeling, managed care contracting, population management, case management, clinical or financial decision support required.
$86,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Manager, Provider Network Contracting - Dallas/Fort Worth market - Cigna Healthcare -Hybrid page is loaded Manager, Provider Network Contracting - Dallas/Fort Worth market - Cigna Healthcare -Hybrid Apply remote type Hybrid locations Plano, TX Fort Worth, TX Dallas, TX time type Full time posted on Posted 5 Days Ago job requisition id 24000806 LOCATION: Hybrid position aligned to the Plano, TX market.
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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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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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IES is a national provider of industrial products and infrastructure servicesto a variety of end markets, including electrical, mechanical andcommunications contracting solutions for the commercial, industrial,residential and renewable energy markets.
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This role includes working with internal teams and customers to identify and develop turnkey design-build solutions and energy savings contracting projects, including scope of work development, cost estimating, working with Energy Engineers to quantify energy savings, and proposal support as part of an industry leading Energy Services Company (ESCO.
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Superior Contracting & Maintenance, a reputable construction company, is seeking a skilled Garage Door Technician to join our team. Superior Contracting & Maintenance has been providing property management companies with clear and effective maintenance and turn-key services for over 14 years.
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As a Garage Door Technician, you will be responsible for installing, repairing, and maintaining garage doors for residential properties. Our comprehensive services include roofing, gutters, siding, painting, concrete driveways, plumbing, electrical, landscaping, general repairs and carpentry, doors and windows, and more.
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7-9 years in provider relations, payor contracting, provider enrollment, payor configuration or provider-facility credentialing Required. Ensures the payor contracting department possesses relevant knowledge of commercial and Medicare Advantage payor enrollment requirements and develops and maintains provider rosters issues and a mechanism for resolving enrollment issues.
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As a General Handyman at Superior Contracting & Maintenance, you'll work to deliver the highest quality repairs and maintenance services to property management companies. With competitive compensation, a great company culture, and the opportunity for growth, Superior Contracting & Maintenance is the ideal place for any handyman to build a career in the construction industry.
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provider contracting jobs Company: Metroplus Health Plan
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