Job Description
Salary: $80,000 - $100,000 / Year Overview:
Elderwood Independent Practice Association (IPA) is seeking a Senior Manager of Network Development to join our incredible growing team of professionals.
The ideal candidate for this role will have experience in some or all these areas/disciplines: Managed Care, Delegated Credentialing and Sanction Monitoring, NCQA, accreditation standards, CMS, PACE.
Why should you join Elderwood IPA?
Monday-Friday Schedule with no weekends or overnights
Hybrid working options
Medical, Dental & Vision upon 1st of month following 60 days of hire
Up to 140 hours (19 days) of PTO time PLUS six (6) holidays within the 1st year
401(k) retirement plan with vested employer match up to 4%
Substantial Referral program
Responsibilities:
Manager of Network Development Overview
Seek opportunities to engage new contracts for Elderwood IPA and partnered health plans, as applicable.
Manage entire contracting process from initially engaging providers to finalizing contract language and rate setting. Participate in negotiation process.
Conduct business review of provider contracts and coordinate with legal and other internal stakeholders to manage comprehensive review of new contracts and amendments.
Oversee signature and countersignature contract process. Responsible for organizing and storing fully executed agreements and contract documents for each provider in contract management system.
Interface with various departments in developing contractual proposals.
Evaluate scenarios, using data analysis, industry knowledge, and information from internal stakeholders. Using this information, present sound recommendations to senior leadership related to contracting and negotiating with providers.
Collaborate with other key Elderwood IPA staff including, but not limited to, finance and business development, to resolve operational issues and assist with process improvement.
Develop and maintain reimbursement tools for organizational use.
Create and maintain contract status summaries and tools to keep senior leadership apprised of status.
Coordinate and complete external reporting to contracted health plans, including credentialing and various required reports and submissions.
Coordinate the management of the credentialing database and associated modules, ensuring accuracy of data and reporting. Monitor critical data for extensive analysis and report generation.
Coordinate the management of the expirables process to ensure all provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
Monitor and report on turnaround times for processing of credentialing applications.
Drive and implement seamless protocols for gathering credentialing data from providers.
Define and implement processes to ensure credentialing is completed and up to date in a timely manner.
Oversee the presentation of provider files to Credentialing Committee.
Oversee the provider monthly monitoring process.
Qualifications:
Educational Requirements and Qualifications
Bachelor's Degree required.
Minimum five to seven years' experience in provider or health plan setting.
Experience in one or more of the following: credentialing, reimbursement, contract review, or data analysis.
Critical thinking and analytical skills required.
Must be familiar with industry standard reimbursement methodologies, including Medicare, Medicaid, and other third-party commercial reimbursement as well as federal and state laws as they relate to those payer payment structures.
Strong interpersonal and communication skills are necessary to effectively work with providers and payers.
Proficiency in Microsoft Word, Excel, Outlook as well as web-based research preferred.
This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.
Must live in Western New York Area
Skills and Competencies
Excellent analytical and critical thinking skills
Strategic thinking skills
Excellent interpersonal and collaborative skills
Exceptional ability to articulate, be persuasive, and assertive
Outstanding verbal and written communication skills
Strong listening skills
Ability to evaluate scenarios with limited information, propose sound solutions, and apply problem-solving skills
Highly analytical and detail-oriented with ability to demonstrate command of details and to articulate those details at a higher level
Demonstrated open-mindedness
Highly organized
Ability to work independently and proactively in a fast-paced, dynamic environment
Able to prioritize multiple deliverables and meet deadlines
EOE Statement: WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
Job Tags
Holiday work, Full time, Contract work, Local area, Monday to Friday,