Duration: 12 Months Contract – To – Hire
Location: Harrisburg / Pittsburgh PA
Job Description:
• Responsible for development and management of provider networks for all products: Medicaid, and Medicare.
• Responsible for hospital and physician network development and management.
• Develops and recommends policy changes related to provider recruitment and contracting.
• Recruits and negotiates contracts with specific providers within operational and potential new counties to meet company requirements.
• Oversees training and communication for network providers and acts as a liaison with the provider community.
• Ensures compliance with pricing guidelines established by AMFC and Plan.
• Ensures provider contracting is consistent with claim payment methodologies.
• Maintains familiarity with Medicare and State Medicaid fee schedules and reimbursement methodologies and analyzes comparable Plan pricing guidelines.
• Resolves difficult complex contract issues to ensure that provider contracts are in compliance with state, federal, national accrediting agencies and Plan contracting guidelines.
• Ensures that non-standard contract elements are communicated to appropriate departments and obtains AMFC and Plan approval prior to submission to provider.
• Responsible for the accuracy and timely management of all provider contracts.
• Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims.
• Responsible for achievement of quality and health plan objectives through accomplishment of provider initiatives
• Bachelor’s degree in business or health related discipline such as Healthcare Administration or Healthcare Management or equivalent business experience required
• Master’s Degree highly preferred.
• Minimum of 5 years provider contracting/reimbursement experience in healthcare setting required
• 1-2 years Medicaid experience required
Best Regards,
NIRMAL CHATTERJEE
Technical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
Direct Line # : 732-429-1911
BOARD # : 732-549-2030 – Ext - 306
www.irionline.com
LinkedIn: https://www.linkedin.com/in/nirmalyachatterjee
Gold Seal JCAHO Certified ™ for Health Care Staffing
Job details are sourced from the employer's original posting.
Open job postingAbout the company
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.