Provider Contract Manager

Preferred Location

Hybrid role with a strong preference for candidates located in the Northwest, OH region.

Under direct supervision, develops and maintains relationships with typically small to medium sized and/or moderately complex provider community via e‑mail, telephonic and face‑to‑face outreach. Develops the provider network and national network offerings through contracting activities, relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and the resolution of provider issues.

• Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks and with internal department staff. Explains contract provisions to internal/external customers.
• Prepares non‑standard contracts, amendments, and extensions. With some assistance, conducts non‑standard contracts, rate, and language negotiations.
• Compiles and analyzes data to support contracting negotiations and/or compliance.
• Serves as a communication link between assigned providers and the Company. Provides provider service and education, including field visits.
• Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers.
• Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, preparing agenda and meeting minutes.
• Identifies program/system enhancements to reduce/minimize issues going forward.
• May collaborate with other key areas on cross‑functional projects.
• Performs other duties as assigned.

• Bachelor's Degree in Business or Healthcare Administration, Finance, or related field.
• In lieu of Degree, may consider an equivalent combination of education and experience.
• Experience in health insurance or a health care related field preferred.

• Intermediate Microsoft Office skills, especially Excel.
• General knowledge of the health care industry and current events.
• Good project management skills.
• Knowledge of provider contract negotiations, regulations, etc.
• Good presentation skills.

Under general supervision, develops and maintains relationships with typically medium to larger sized and/or complex provider community via e‑mail, telephonic and face‑to‑face outreach. Develops the provider network and national network offerings through contracting activities, contract negotiations (language and rates), drafting contracts, amendments, and extension documents, managing relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and resolution of provider issues.

• Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks and with internal department staff. Explains contract provisions to internal/external customers.
• Compiles and analyzes data to support contracting negotiations and/or compliance.
• Researches and resolves complex issues that may impact future negotiations or jeopardize network retention. Reviews financial impact analyses, projections and develops negotiation work papers. Makes recommendations to assist in complex negotiations.
• Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, driving the meetings in the discussions of issues and changes.
• Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers.
• Serves as a communication link between all assigned providers or…