Job Title

Why Choose Jefferson Health Plans?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 OptionsBenefits & 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! Manage the Provider Contract OperationsAdministration processes and functions to support Health Partners Plans' mission and business objectives and comply with JHP's policies and procedures. Manage direct internal reports to ensure those provider agreements are current, tracked, and stored in a functional and timely manner. Manage the development and control of template provider contracts as well as track, monitor, and trend terms and rates with a physician, ancillary, and hospitalhealth system facility contracts and related activities as directed by the Director, Provider Contracting to ensure optimal network access, cost-effectiveness, regulatory compliance, and operational effectiveness. Work closely with internal departments to ensure that negotiated contracts can be implemented into the claims system and that the contract set-up process is correct from the business perspective. Ensure that Health Partners Plans' departments know and agree with the contract terms that impact their areas of responsibility. Manage and lead other contracting-related initiatives and activities as assigned. As the Manager, Provider Contracting Operations, your daily duties may include... Manage the Contract Administration team and processes, including tracking and monitoring standard and nonstandard contracts as they go through the internal and signature processes. Ensure they are stored in a secure, accessible, and organized electronic filing system. Oversee the end-to-end process for the contracting lifecycle; this includes but is not limited to credentialing, provider data management, and pricingconfiguration.Manage the development and utilization of appropriate Provider contract templates. Work closely with Director, Provider Contracting, Compliance, Legal, or other management to ensure that all terms and revisions meet legal, regulatory, and accreditation requirements and support HPP's mission and business objectives. Manage the options for negotiation alternatives for rates and language terms for existing and new expansion physicians, ancillary, hospitalhealth systems, and other related provider agreements for existing and new providers. Manage workflow and partner with internal departments and teammates to ensure provider information tracking grids are accurate and readily available, including but not limited to Contracting Calendar and RatePayment Grids.Maintain and foster collaborative relationships with ancillary, hospital, health system executives, and other internal and external customers. Develop and evaluate departmental workflows and policies & procedures, revise as appropriate. Chair the ProviderHospital Termination Workgroup, as needed, which includes multiple HPP department representatives and ensures that all large providerhospital terminations are handled in compliance with DHS, CMS, and other regulatory bodies' standards and requirements and to ensure a smooth termination process and continuity of care to members and timely completion of associated functions.Manage budget and control expenses while meeting operational, financial, and service requirements.Coach and lead the team to continuously improve operational performance.Maintain a positive work environment that supports self-direction; provide a structure to optimize the team's experience, skill, knowledge, and capability.Establish benchmarks for performance based on industry, regulatory and accreditation requirements and goals and objectives.Perform job duties in compliance with policies and procedures of Network Management and Health Partners Plans.Stay well-informed of industry trends in physician, ancillary, and hospital and provider contracting and advise senior management of trends and issues that impact HPP. Facilitate task forces, work teams, special projects, and other duties as assigned. Qualifications and Skills, we value Education: Bachelor's Degree or equivalent work experience in a managed care, hospital or other health care related organization, with coursework in health careWork experience may be substituted for specific health care related coursework.3-5 years of experience in a managed care setting (payer or provider based), with experience in physician, ancillary and hospital contracting, hospitalprovider reimbursement, provider recruitment, customer service and claims payment. Prior experience with a government programs health plan preferred, but not required. SkillsAbilities: Superior verbal and written communication skillsStrong negotiation, conflict resolution, organization, project management skills. Strong quantitative analytic abilities. Careful attention to detail. 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 hospitalprovider payment methodologies, sufficient to analyze cost and operational impact. Familiarity with claims payments processes and systems.