Contracting Systems Manager – Health Plan

• Serve as the Contracting subject matter expert for QNXT, contract management system, and other enterprise system implementations.
• Provide oversight and validation of contract-to-configuration alignment to ensure provider agreements are accurately operationalized.
• Review complex reimbursement methodologies and contract provisions to identify risks associated with system configuration and claims adjudication.
• Lead contract-related testing activities including UAT, parallel testing, payment validation, and go-live readiness assessments.
• Identify, investigate, and elevate discrepancies between contract intent and system outcomes.
• Partner with Configuration, Claims, IT, Provider Operations, and implementation teams to develop solutions for contract implementation issues.
• Establish and maintain processes and controls that support ongoing contract-to-system accuracy.
• Serve as the primary business resource for contract implementation, renewals, amendments, and system enhancement initiatives.
• Analyze operational and financial impacts of contract implementation decisions and provide recommendations to leadership.
• Lead special projects and process improvement initiatives supporting enterprise contracting and payment accuracy objectives.

• Bachelor's degree or equivalent experience in Healthcare Administration, Business Administration, Finance, Information Systems, Public Health, or related field
• 5+ years of experience in managed care, provider contracting, network management, claims operations, configuration support, healthcare systems implementation, or related healthcare or health insurance plan operations.
• Experience interpreting and applying complex provider contract terms, reimbursement methodologies, and payment arrangements.
• Experience participating in large-scale operational or technology implementations.
• Experience collaborating across multiple business functions, including Contracting, Claims, Configuration, Operations, Network Management, Finance, and Information Technology.
• Experience supporting testing, validation, issue resolution, implementation readiness, and production support activities for business-critical systems.
• Strong analytical experience identifying operational, financial, payment, and implementation risks and developing recommendations for resolution.
• Microsoft Office (Word, Excel, PowerPoint, Teams, Outlook) at advanced skill level.

Demonstrates expertise in Contract Management and Healthcare Systems Implementation, with a strong focus on contract-to-configuration alignment, risk analysis, and process improvement. Proficient in leading testing activities and collaborating across multiple business functions to ensure operational accuracy and compliance.

• Contract Management Expertise
• Healthcare Systems Implementation
• Risk Analysis and Mitigation
• Testing and Validation Leadership
• Cross-Functional Collaboration

• Contract Interpretation
• Reimbursement Methodologies
• Claims Operations
• Configuration Support
• Operational Analysis
• Financial Impact Analysis
• Issue Resolution
• Implementation Readiness
• Process Improvement
• Advanced Microsoft Office

• Analytical Thinking
• Problem Solving
• Communication
• Collaboration
• Leadership

• Managed Care
• Provider Contracting
• Network Management
• Health Insurance Operations
• Healthcare Administration

• QNXT
• Contract Management Systems
• Enterprise Systems