Provider Contracting Outreach/Data Manager

Position Overview

Provide rate analysis support to the management team of Provider Contracting responding to requests for rate changes by contracted and new recruitments to the MetroPlusHealth provider network. In addition to providing technical administrative support for key network development/outreach and contracting activities; this position will also participate in contract negotiations.

Scope of Role & Responsibilities

• Manage numerous projects assigned to Provider Contracting team with respect to Regulatory/ Compliance issues/ changes as well as projects for right sizing the provider network and recruitment of new provider entities.
• Aid in compiling data related to providers requesting rate changes/nonstandard rates—current and prospective providers—to assist management with decision making. Relevant data will include Provider claims utilization experience/provider type/size/specialty(ies)/geographic presence/membership (as applicable).
• Participate and assist with contract negotiations for new and existing contracts.
• Develop rate change impact analysis models for professional services/ancillary services, and facilities for management team’s use to assess appropriate rate proposals and counters.
• Aid in monthly and quarterly reporting of Provider Network Development activity—specifically provider recruitment outreach initiatives.
• Aid in monthly metrics reporting for OON team activity (SCAs).
• Manage the updates to the appropriate systems used to reflect provider contract status.
• Aid in updating contracting information in Contracting Database (amendments, terminations, rates).
• Work with Plan’s Health Analytics team to run and develop reports that will support Provider Contracting team to resolve contract related issues, and coordinate resolutions with other internal departments, including Claims, Credentialing, Provider Maintenance, Provider Network Operations, and others.
• Work on special projects as needed, and assist in all areas of the Provider Contracting Department

Required Education, Training & Professional Experience

• Bachelor’s Degree, preferably in Health Care Administration, Business Administration, or other related areas of study required.
• Minimum of five (5) years’ experience with a managed care plan and good working knowledge of managed care concepts and organizational functions.
• Proficient in computer applications including MS Office including Word, Excel, and Access.
• Excellent organization and project management skills.

Professional Competencies

• Demonstrates strong integrity and builds trust
• Maintains a clear focus on customer needs and satisfaction
• Possesses solid functional and technical expertise
• Communicates effectively, both verbally and in writing
• Exhibits strong analytical, written, and verbal communication skills
• Shows excellent interpersonal and relationship-building abilities
• Demonstrates strong organizational and project management skills