We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.
Perks of JHP and why you will love it here:
Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
Flextime and Work-at-Home Options
Benefits & Wellness Program including generous Time Off
Impact on the communities we service
We are hiring a Manager, Provider Contracting Operations to join our team remotely!
The Manager of Provider Contracting Operations oversees the Provider Contracting team'steam's operations, data, and workflows. The Manager is responsible for managing the provider contracting end-to-end processes, which include the contract execution process, updates to the provider data systems, and tracking tools for all JHP contracts. In addition, the Manager creates and updates the department'sdepartment's operating procedures and workflows. Finally, as required, the Manager maintains and updates the corporate provider contracting templates for all provider types.
As the Manager, Provider Contracting Operations, your daily duties may include...
Manage the Contract Operations team and processes, including tracking and monitoring standard and nonstandard contracts as they go through execution and implementation.
Ensure that contract data and information are stored in the JHP contract management system.
Manage the development and content of the hospital, professional and ancillary provider contract templates. Work closely with contracting, legal, and other stakeholders to ensure that all terms and revisions meet legal and regulatory requirements.
Align and modify provider contracting templates to support JHP's mission and business strategies.
Develop and oversee departmental workflows and policies and procedures. Modify processes as needed.
Update contract management system with information and data from executed provider contracts.
Support network adequacy analytics with data and information from the contract management system.
Perform job duties in compliance with policies and procedures of Jefferson Health Plans.
Additional duties as assigned.
Qualifications and Skills, we value
Education:
Bachelor's Degree or six years' relevant experience
3-5 years of experience in a managed care or healthcare setting (payer or provider based), with experience in physician, ancillary and hospital contracting, healthcare or payer operations, provider recruitment, and/or claims payment.
Preferred experience in management and/or leadership.
Prior experience with a government programs health plan preferred, but not required.
Ability to represent Health Partners Plans independently with external providers and senior level hospital and health system executives.
Intermediate to advanced use of Microsoft Excel and Word, knowledge of current health care industry and knowledge of governmental program hospital/provider payment methodologies, sufficient to analyze cost and operational impact.
Familiarity with claims payments processes and systems.