Provider Contracting Director jobs in Pittsburgh, PA

Provider Contracting Director is responsible for the operations of the provider contracts department. Ensures that provider contracts are processed to support accurate and efficient claims payments. Being a Provider Contracting Director oversees the formulation of provider contracts and specific terms. Analyzes contract data and provides financial projections. Additionally, Provider Contracting Director requires a bachelor's degree. Typically reports to top management. The Provider Contracting Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Provider Contracting Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

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Manager, Provider Contracting Operations
  • Health Partner Plans, Inc.
  • Pittsburgh, PA FULL_TIME
  • 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 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, Provider Contracting Operations oversees the Provider Contracting team 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’s operating procedures and workflows. Finally, the Manager maintains and as required, 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.
    • Manage contract renewal calendar and key event (e.g., increases, contract terms, unique provisions) tracking system.
    • 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
    • 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.
    Skills/Abilities:
    • Superior verbal and written communication skills
    • Strong 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 hospital/provider payment methodologies, sufficient to analyze cost and operational impact.
    • Familiarity with claims payments processes and systems.
  • 6 Days Ago

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Provider Contracting Specialist
  • Wexford Health
  • Pittsburgh, PA FULL_TIME
  • To Apply for this Job Click Here POSITION: Provider Contracting Specialist SCHEDULE: Full-Time (Monday-Friday 8:30AM – 5PM) FACILITY: Wexford Health Sources, Inc. Corporate Office LOCATION: Green Tree...
  • 11 Days Ago

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Practice Manager - Dental Site
  • Provider Openings
  • Rochester, PA FULL_TIME
  • Position Overview The Practice Manager I will be responsible for supervision of our Rochester Dental site and will effectively carry out the Network’s Policies and Procedures while communicating manag...
  • 4 Days Ago

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Practice Manager - Dental Site
  • Provider Openings
  • Rochester, PA FULL_TIME
  • Position Overview The Practice Manager I will be responsible for supervision of our Rochester Dental site and will effectively carry out the Network’s Policies and Procedures while communicating manag...
  • 4 Days Ago

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LCSW LPC
  • Provider Openings
  • Rochester, PA FULL_TIME
  • At The Primary Health Network, we believe that every person deserves access to high quality healthcare services regardless of race, color, national origin, age, disability, sex or ability to pay. We p...
  • 8 Days Ago

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LCSW LPC
  • Provider Openings
  • Clarion, PA FULL_TIME
  • At The Primary Health Network, we believe that every person deserves access to high quality healthcare services regardless of race, color, national origin, age, disability, sex or ability to pay. We p...
  • 10 Days Ago

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0 Provider Contracting Director jobs found in Pittsburgh, PA area

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Optical Provider Relations Coordinator
  • VBA
  • Carnegie, PA
  • As Vision Benefits of America (VBA) continues to enjoy unprecedented growth, we have a business need to expand internal ...
  • 4/22/2024 12:00:00 AM

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Cleaning Provider / PT Greensburg (ECHRSS)
  • Safari Contract Cleaners
  • Greensburg, PA
  • >> Cleaning Provider / PT Greensburg (ECHRSS) Cleaning Provider / PT Greensburg (ECHRSS) Summary Title:Cleaning Provider...
  • 4/22/2024 12:00:00 AM

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Advanced Practice Provider
  • Genesis Healthcare
  • Pittsburgh, PA
  • Sub-Acute, Long-Term Care is a sector of healthcare exploding with potential and work-life balance flexibility (no on ca...
  • 4/21/2024 12:00:00 AM

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Advanced Practice Provider
  • Genesis Health
  • Pittsburgh, PA
  • Sub-Acute, Long-Term Care is a sector of healthcare exploding with potential and work-life balance flexibility (no on ca...
  • 4/21/2024 12:00:00 AM

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Medicare Provider Relations Representative
  • The Cigna Group
  • Pittsburgh, PA
  • SUMMARY: This position is an external provider facing role with account management responsibilities for a medium to low ...
  • 4/20/2024 12:00:00 AM

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Accounting Administrator
  • Tech Providers Inc
  • Pittsburgh, PA
  • Position : Accounting Administrator Location: Pittsburgh, PA 15205 (Onsite) Duration: 6+ Months (Contract to Hire) Job R...
  • 4/19/2024 12:00:00 AM

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Sewing Machine Operator / Laborers TRAINING PROVIDED!
  • Ohio Valley Industrial Services
  • West Mifflin, PA
  • Job Description Job Description Since 1981, family owned and operated Ohio Valley Industrial Services has been about ser...
  • 4/18/2024 12:00:00 AM

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Accounting Administrator
  • Tech Providers Inc
  • Pittsburgh, PA
  • Position : Accounting Administrator Location: Pittsburgh, PA 15205 (Onsite) Duration:6+ Months(Contract to Hire) Job Rol...
  • 4/18/2024 12:00:00 AM

Pittsburgh (/ˈpɪtsbɜːrɡ/ PITS-burg) is a city in the Commonwealth of Pennsylvania in the United States, and is the county seat of Allegheny County. As of 2018, a population of 308,144 lives within the city limits, making it the 63rd-largest city in the U.S. The metropolitan population of 2,362,453, is the largest in both the Ohio Valley and Appalachia, the second-largest in Pennsylvania (behind Philadelphia), and the 26th-largest in the U.S. Pittsburgh is located in the south west of the state, at the confluence of the Allegheny, Monongahela, and Ohio rivers. Pittsburgh is known both as "the ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Director jobs
$169,928 to $245,421
Pittsburgh, Pennsylvania area prices
were up 1.9% from a year ago

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