Network Contract Maintenance Manager

About the role

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values—Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

Responsibilities

• Oversee the accurate collection, validation, and maintenance of provider information, including addresses, specialties, taxonomies, TINs, NPIs, contracts, fee schedules and credentialing status.
• Ensure timely processing of provider additions, terminations, updates, and demographic corrections in accordance with regulatory or partner requirements.
• Implement and maintain processes for validating provider data received from internal networks, health plans, or provider groups.
• Monitor and manage data discrepancies, duplicates, or mismatches within the provider database.
• Manage the loading of network configurations, fee schedules, provider pricing, contract rules, and reimbursement logic into repricing and TPA systems.
• Oversee configuration of benefit, network, and pricing tables to support accurate claims adjudication.
• Perform quality assurance and audits to validate configuration and fee schedule accuracy and system integrity.
• Coordinate with IT to troubleshoot provider file issues, system errors, or configuration defects.
• Lead user acceptance testing (UAT) for new system functionality, upgrades, or network changes.
• Serve as the primary point of contact for external network partners, provider groups, and repricing vendors regarding rosters, demographic maintenance, and contract management.
• Review and interpret provider contracts and network participation documents to ensure proper system setup.
• Support network audits, provider data reconciliation, and process improvements with external partners.
• Collaborate with Claims, Provider Relations, Client Services, Compliance, vendor partners and IT to ensure provider data supports operational accuracy and service goals.
• Provide subject matter expertise for provider contract setup, pricing logic, and network hierarchy.
• Participate in client implementations and renewals to configure provider networks, repricing and fee schedule management.
• Supervise and develop a team of provider data analysts, configuration specialists, or Network Maintenance staff.
• Establish performance metrics, monitor workloads, and ensure adherence to quality and timeliness standards.
• Create and maintain department documentation, workflows, SOPs, and training materials.
• Ensure provider contract data processes comply with federal and state regulations, including credentialing standards, and network adequacy requirements.
• Maintain audit trails for all provider updates and configuration changes.
• Lead process improvement initiatives to increase automation, accuracy, and operational efficiency.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Information Systems, or related field; or equivalent experience.
• 5+ years of experience in provider data management, network configuration, or network operations within a TPA, health plan, PPO network, or similar environment.
• Strong understanding of provider network structures, provider reimbursement methodologies, and how configurations impact claims adjudication.
• Experience working with provider rosters, contracts, fee schedules, and demographic files.
• Proficiency with provider databases, claims systems, and configuration platforms.
• Strong analytical, technical, and problem-solving skills with a focus on data integrity.
• Excellent communication skills and ability to collaborate across teams.
• Previous supervisory or team-lead experience preferred.
• Familiarity with PPO networks, leased networks, repricers, or provider data exchange standards preferred.

Skills

• Data Integrity Focus – Ensures accuracy in provider demographic and network configuration data.
• Technical Aptitude – Understands claim system configuration, file structures, and data flows.
• Leadership & Coaching – Effectively develops and supports team members.
• Analytical Thinking – Interprets provider contracts, pricing rules, and configuration logic.
• Collaboration – Works effectively with internal departments and external partners.
• Quality Orientation – Prioritizes accuracy, compliance, and continuous improvement.
• Must be articulate, possess a professional business manner and have excellent organizational and communication skills.
• Strong ability to identify appropriate resources for research and problem resolution.

Physical and Mental Abilities

• Ability to perform sedentary work for extended periods of time.
• Ability to utilize personal computer, telephone system, and communicate with a variety of customers.
• Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Paid training
• Vision insurance