Provider Contracting Manager

About the role

The Provider Contracting Manager at Community Health Choice is responsible for network development and management. This role involves expanding provider networks for existing and new lines of business, negotiating provider agreements, ensuring regulatory compliance, and maintaining effective relationships with providers.

Responsibilities

• Negotiate contract language and rates with hospital, physician, ancillary, and LTSS providers in accordance with established parameters and guidelines.
• Collaborate with Compliance, Legal, and Credentialing teams to finalize provider contracts, including amendments and new agreements.
• Ensure compliance with regulatory and product requirements related to provider contracting, including network adequacy standards.
• Actively seek opportunities to expand provider networks for existing and new lines of business.
• Conduct external meetings with prospective and existing providers to negotiate or renegotiate agreements.
• Collaborate with other relevant teams to facilitate network expansion efforts.
• Ensure compliance and network adequacy, making necessary adjustments to meet regulatory standards.
• Coordinate with Network Management, Claims, and Provider Data Integrity teams to ensure accurate contract reimbursement and adherence to requirements.
• Contribute to departmental goals as outlined in the annual business plan.
• Participate in departmental process improvement initiatives to enhance operational efficiency and effectiveness.
• Serve as a liaison between Community Health Choice and its providers, facilitating communication and addressing any issues that arise.
• Resolve problems and ensure smooth operations by maintaining positive relationships with providers.

Qualifications

• Bachelor's degree required.
• Minimum of three (3) years of experience in healthcare, providers/managed care, contracting, and relations with degree.
• Experience with Star Plus, LTSS, HCBPs, and Medicare products is a plus.
• Must have a vehicle and a valid State of Texas Driver's License.