Regulatory Provider Contracting & Reimbursement Manager

Provider Contracting And Reimbursement Specialist

Under the guidance of VP Network Management, this role is responsible for assigned provider contracting and reimbursement and recruitment. Meets customer needs for information, status, and issues. Keeps management apprised of issues and status. Identifies opportunities for improvement, facilitates peer review activities, facilitates problem solving sessions, acts as a catalyst for change and constantly seeks opportunities to improve team functioning.

Essential Accountabilities :

• Responsible for a variety of hospital, ancillary and / or physician contract negotiations as assigned.
• Responsible for the development of provider fee schedules.
• Meets with providers to understand their issues and concerns.
• Works collaboratively with providers and health plan staff to address provider issues.
• Applies principles of total quality management, team leadership and peer review on a consistent, ongoing basis. Assists teammates in identifying improvement opportunities.
• Facilitates problem solving which leads to practical, mutual agreeable outcomes.
• Identifies practical consequences of team suggestions and builds consensus to achieve results.
• Will continuously work to identify and remove barriers to increased productivity, quality, cost effectiveness, and timeliness of operations and customer satisfaction.
• Manages multiple priorities. Works with staff both within and outside of Network Management to meet information needs and support Health Plan goals.
• Serves as a mentor to teammates by setting and striving to achieve high levels of professional competence. Leads by example.
• Participates and represents regional Network Management team in various inter-regional committees, as applicable.
• Collaborates with regional and corporate departments to develop new provider contract, reimbursement and incentive models.
• Routinely performs analysis to meet customer needs, in order to maximize contributions, act as a knowledgeable and credible resource, solicit teammate contributions, identify cross-functional improvement opportunities, etc.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications :

Physical Requirements :

Equal Opportunity Employer

Compensation Range(s) : Min : $65,346 - Max : $117,622