Provider Contracting Manager jobs in Chicago, IL

Provider Contracting Manager manages the activities of the contracting staff that prepare and maintain contracts and the contracts database system for a health plan network. Responsible for negotiating with facilities joining the health network and setting rates. Being a Provider Contracting Manager oversees network reporting requirements to ensure compliance with regulatory agencies, and to produce accurate and relevant reporting of data. Trains and develops staff. Additionally, Provider Contracting Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Provider Contracting Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Provider Contracting Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Manager Payor Provider Contracting Managed Care
  • USA Clinics Group
  • Lincolnshire, IL CONTRACTOR,FULL_TIME
  • The Manager Payor Provider Contracting Managed Care will provide strategic direction for and oversight of all managed care network development activities, oversee negotiation of all managed care contracting activities for fee-for-service (FFS) agreements, and leading and directing strategic activities associated with negotiating, implementing, and maintaining complex managed care contracts and relationships with third party risk bearing entities (i.e. payers and providers). Achieving this by working collaboratively with Revenue Management and Information Services departments to address operations, utilization and reimbursement issues Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout the contract life cycle.

    Only candidates who can reliably commute to the position's location in Northbrook, Illinois will be considered.

    Responsibilities

    Oversees the negotiation of all managed care contracting activities including but not limited to:

    All for fee-for-service (FFS) agreements

    All "ad-hoc" individual case agreements in accordance with policies and standards.

    Negotiating complex managed care contracts and securing optimal reimbursement rates that maximize utilization and increase value.

    Lead and Direct all strategic activities associated with negotiating, implementing, and maintaining complex managed care contracts and relationships with third party entities.

    Work within an evolving business line to coordinate contract negotiation, implementation, and administration for Client's new healthcare services and solutions.

    Monitor and analyze performance of third-party payer agreements including profitability, volume, strategic initiatives and payer/provider compliance issues Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations in regard to Managed Care contracts

    Achieve and maintain a full understanding of Medicare and or Medicaid pricing reimbursement and structure for both Payors & providers.

    Partner with the management team to identify, develop, and implement appropriate approaches, processes, and tools that elevate the analytics group.

    Lead the implementation of managed care contracts with internal departments to develop and maintain systems to disseminate contract information.

    Lead and manage the contract terms and commitments to assure all deliverables are adhered to and take proactive measures before key milestones are missed.

    Work with corporate and field on any reimbursement issues and brings exceptions or non-standard requests to the attention of senior management where appropriate.

    Maintain communication regarding third party participation, contract compliance, and any other operational issues or opportunities.

    Review Third Party medical adherence Contracts to ensure operational requirements can be met and implemented.

    Negotiate, analyze and model current, proposed, and final pricing terms for payors in accordance with pricing standards.

    Lead the development and implementation of an annual strategic plan for third party payer contracting, including the continued development of opportunities and implementation of pricing strategies and contract language standards.

    Monitor the technical links between the Third-Party Provider and data tracking systems to assure reported issues are properly captured, reported, prioritized and managed to closure.

    Work with appropriate internal and external parties to load and update new/existing location, market, and provider information.

    Manage and audit the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate profit and reimbursement.

    Perform additional duties as assigned.

    Requirements

    Bachelor's degree, required

    5 years in a similar role, required.

    5 years monitoring and analyzing performance of third-party payer agreements including profitability, volume, strategic initiates, and payer/provider compliance issues, required

    Ability to work within an evolving business line to coordinate contract negotiation, implementation, and administration for Client's new healthcare services and solutions.

    Expertise in managed care contracts of healthcare services, and their respective business issues and potential opportunities.

    Benefits

    Health

    Dental

    Vision

    401K & Company Match

    PTO

  • 8 Days Ago

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Senior Manager Payor Provider Contracting Managed Care@ Chicago, IL (Chicago, IL)
  • CEDENT
  • Chicago, IL FULL_TIME
  • Title: Senior Manager Payor Provider Contracting Managed Care@ Chicago, IL Terms of Hire: Full time. Salary: $ 140,000–$148,000 / YR Benefits Job description Provide strategic direction for and oversi...
  • 1 Month Ago

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Product and Contracting Manager
  • ABERCROMBIE & KENT USA LLC
  • Downers Grove, IL FULL_TIME
  • Position SummaryAs the Product and Contracting Manager for the USA & Canada DMC, you will oversee all facets of product development and contracting. This includes spearheading product and destination ...
  • 8 Days Ago

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Direct Contracting Manager - Chicago Area
  • TriWest Healthcare Alliance
  • Chicago, IL FULL_TIME
  • Profile Veterans, Reservists, Guardsmen and military family members are encouraged to apply!! We offer remote work opportunities (AK, AR, AZ, *CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, N...
  • 1 Day Ago

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Project Manager - Job Order Contracting (JOC) - Chicago
  • Michael Page
  • Chicago, IL FULL_TIME
  • About Our Client This firm does an average of $50M a year and has been around for over 50 years. This contractor does work across a couple different states and they're looking for someone to add to th...
  • 13 Days Ago

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Regional Safety Manager
  • Performance Contracting Group
  • Zurich, IL OTHER
  • Company Overview Performance Contracting Group is a national employee-owned specialty contractor that offers quality services and products to the commercial, industrial, and non-residential constructi...
  • 1 Month Ago

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0 Provider Contracting Manager jobs found in Chicago, IL area

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Senior Pricing and Contract Manager
  • PATRIN PHARMA, INC.
  • Chicago, IL
  • Company Description Patrin Pharma, Inc. is a generic pharmaceutical company located in a northern Chicago suburb that ha...
  • 4/26/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Chicago, IL
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Contract Manager
  • Robert Half
  • Chicago, IL
  • Job Title: Contracts Manager Location: Chicago, IL. WILL NOT CONSIDER ANY REMOTE APPLICANTS OR NEW GRADS Job Type: Full-...
  • 4/24/2024 12:00:00 AM

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Contracts Manager
  • Enru Logistics and Postal Optimization
  • Chicago, IL
  • Enru Logistics & Postal Optimization is a technology-first logistics and postal optimization business which partners wit...
  • 4/24/2024 12:00:00 AM

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Project/Contract Manager
  • Paragon Systems Inc
  • Chicago, IL
  • Are you an Experienced Security Professional, looking for your next opportunity? Do you have experience Leading TEAMS an...
  • 4/24/2024 12:00:00 AM

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Contracts Manager
  • Coldquanta Inc.
  • Chicago, IL
  • Infleqtion is a global quantum technology company solving the worlds most challenging problems. The company harnesses qu...
  • 4/23/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Chicago, IL
  • Position: Provider Contract Manager *REMOTE Seattle Area* Location: Remote - Everett, Seattle, Tacoma, Washington State ...
  • 4/22/2024 12:00:00 AM

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Product and Contracting Manager
  • Abercrombie & Kent Destination Management
  • Downers Grove, IL
  • Position Summary As the Product and Contracting Manager for the USA & Canada DMC, you will oversee all facets of product...
  • 4/22/2024 12:00:00 AM

Chicago (/ʃɪˈkɑːɡoʊ/ (listen), locally also /-ˈkɔː-/), officially the City of Chicago, is the most populous city in Illinois, as well as the third most populous city in the United States. With an estimated population of 2,716,450 (2017), it is the most populous city in the Midwest. Chicago is the principal city of the Chicago metropolitan area, often referred to as Chicagoland, and the county seat of Cook County, the second most populous county in the United States. The metropolitan area, at nearly 10 million people, is the third-largest in the United States, and the fourth largest in North A...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Manager jobs
$114,526 to $152,091
Chicago, Illinois area prices
were up 0.8% from a year ago

Provider Contracting Manager in Scranton, PA
In order to properly oversee provider contracts, insurance companies must ensure all the medical professionals they are contracting with are properly credentialed; maintain detailed price sheets to standardize how much they are paying for services; and keep historical records of each account.
December 11, 2019
Provider Contracting Manager in Allentown, PA
The complete report provides the full listing of all companies nominated, as well as benchmark ratings for a listing of 40+ companies in account support and contracting.
January 16, 2020
Provider Contracting Manager in Savannah, GA
The Senior Provider Contract Manager is responsible for developing, negotiating, managing and leading complex contractual, legal and financial arrangements with providers that ensure CCA members have superior access to the highest quality, cost-effective providers of healthcare services.
January 03, 2020