Provider Contracting Manager jobs in Pittsburgh, PA

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, 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.
  • 10 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...
  • 15 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...
  • 8 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...
  • 8 Days Ago

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Manager of Billing and Payer Contracting
  • ZOLL LifeVest
  • Pittsburgh, PA FULL_TIME
  • Location: Pittsburgh, PA, United States of America Cardiac Management Solutions At ZOLL, we're passionate about improving patient outcomes and helping save lives. We provide innovative technologies th...
  • 9 Days Ago

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Manager of Billing and Payer Contracting
  • Zoll Medical Corporation
  • Pittsburgh, PA FULL_TIME
  • Manager of Billing and Payer Contracting Location: Pittsburgh, PA, United States of America Cardiac Management Solutions At ZOLL, we're passionate about improving patient outcomes and helping save liv...
  • 9 Days Ago

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0 Provider Contracting Manager jobs found in Pittsburgh, PA area

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General Manager of Service Operations
  • Talerico Group
  • Pittsburgh, PA
  • About Us: This role is for a company that is a premier single-source provider of mechanical/HVAC, plumbing, and fire ala...
  • 4/26/2024 12:00:00 AM

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Project Manager Design Build
  • Brayman Construction
  • Saxonburg, PA
  • Brayman Construction Corporation in Saxonburg, PA, the suburb of Pittsburgh, is actively seeking a dependable full-time ...
  • 4/26/2024 12:00:00 AM

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Clinical Trials Contract Manager
  • System One
  • Pittsburgh, PA
  • Title: Clinical Trials Contract Manager Location: Pittsburgh, PA - On-site ideal/Remote considered Type: Full Time, Sala...
  • 4/24/2024 12:00:00 AM

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Structure/Bridge Project Manager
  • Jacobs Solutions Inc.
  • Coraopolis, PA
  • Your Impact:Our People & Places Solutions business - reinforces our drive to improve the lives of people everywhere and ...
  • 4/24/2024 12:00:00 AM

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Program / Contract Manager
  • Battelle Memorial Institute
  • Pittsburgh, PA
  • Battelle delivers when others cant. We conduct research and development, manage national laboratories, design and manufa...
  • 4/22/2024 12:00:00 AM

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Operations Coordinator
  • Housing Authority of the City of Pittsburgh
  • Pittsburgh, PA
  • Job Description Job Description Summary The primary purpose of this position is to manage the administration functions o...
  • 4/22/2024 12:00:00 AM

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General Manager of Service Operations
  • Talerico Group
  • Pittsburgh, PA
  • About Us: This role is for a company that is a premier single-source provider of mechanical/HVAC, plumbing, and fire ala...
  • 4/22/2024 12:00:00 AM

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Director Plant Operations
  • Life Space Communities
  • Pittsburgh, PA
  • Community: Friendship Village of South Hills Address: 1290 Boyce Road Upper St Clair, Pennsylvania 15241 Pay Range $83,6...
  • 11/15/2023 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 Manager jobs
$107,538 to $142,811
Pittsburgh, Pennsylvania area prices
were up 1.9% 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