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Network Operations Manager

Remote:

Full Remote

Contract:

Full time

Experience:

Senior (5-10 years)

Work from:

Texas (USA), United States

Offer summary

Qualifications:

Bachelor's degree or equivalent experience, 7+ years in provider contracting/health insurance, Experience with physician/group contracting, Superior problem solving and negotiating skills, Understanding of financial acumen.

Key responsabilities:

Manage provider contracting process for health plan
Collaborate with multiple departments for optimization
Establish a contract review policy and procedure
Lead compliance with regulations and governance committee
Create and maintain a library of model contracts

Curative Scaleup https://curative.com/

201 - 500 Employees

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Job description

Responsibilities

Manage the provider contracting process for a rapidly growing health plan, including

Assuring that negotiators are efficient in their use of the correct documents
Assuring that contracts are meeting standards
Assuring contracts flow smoothly through the processes and that Claims Operations can load the contract into our claim system.

Collaborate with network contracting colleagues, as well as legal department, compliance, credentialing and claim operations to optimize and streamline the contracting process.
Establish an end-to-end provider contract review policy and procedure incorporating the negotiation of language and rates to the entry in the claim system
Manage all policies and procedures impacting the network development and credentialing teams; including development of new processes
Lead the market fee schedule governance committee and ensure compliance with federal and state regulations
Own and update the provider resources, as needed, to comply with regulations or expansion; including but not limited to the Provider Manual
Identify potential risks associated with contracting activities and propose mitigation strategies
Assist with internal and external audits
Partner with Compliance to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity
Create and maintain a library of approved “Model Contracts” for hospitals, physicians/group, and ancillary providers
Reduce/eliminate rework or mitigation of unfavorable contract terms over time

Position Requirements

Bachelor’s degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insurance
Remote with occasional travel (5%)
7+ years of experience with health plan or provider organizations
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
Experience with physician group and ancillary provider contracting language and reimbursement
Experience reviewing delegated credentialing agreements
Demonstrated experience in seeking out, building and nurturing strong internal and external relationships
Team player with proven ability to develop strong working relationships within a fast-paced organization
Customer centric and interpersonal skills are required.