- VSolvit LLC (Huntsville, AL)
- …deep GovCon expertise,proven negotiation success,and the ability to integrate contracting strategywith finance, legal, and business development functions and will ... play a pivotal role in shaping contracting policy, ensuring cost-effective execution, and supporting the company's growth from small or mid-tier contractor status… more
- Unknown (Waltham, MA)
- …to lead a cross-functional team responsible for all aspects of payer and provider access strategy, policy insights, strategic pricing, contracting , and account ... background in specialty pharmacy, buy and bill coverage, and reimbursement , who can build and lead teams to ensure...developing team members, and ensuring compliance with legal and regulatory standards. Candidates for this role at the company… more
- Unknown (Raleigh, NC)
- …organizations or behavioral health networks, as well as experience in payer contracting , managed care negotiations, and reimbursement modeling, is essential. The ... is seeking a Head of Revenue Cycle Management to provide executive oversight and strategic leadership for all revenue...a focus on accuracy, efficiency, and alignment with payer, regulatory , and organizational standards. The Head of RCM will… more
- CareFirst (Baltimore, MD)
- …Understanding of multiple reimbursement methodologies used in healthcare provider contracting , including third party payment methodologies, delegated ... care. This role will also oversee complex projects related to provider contracts, reimbursement methods, documentation and amendments, and participate… more
- Henry Ford Health System (Grand Rapids, MI)
- …send contracts to providers, and track contracts through approval process. + Prepare Provider Reimbursement Worksheets (PRW's) and or Ancillary Reimbursement ... Assist and assume responsibility for focused projects within the department relating to provider contracting . + Perform other related duties as assigned. HAP Pay… more
- Sanford Health (Sioux Falls, SD)
- …needs of Sanford Health Plan membership. Oversees development and execution of provider contracting strategies. Identifies and creates processes to establish ... **Job Schedule:** Full time **Weekly Hours:** 40.00 **Job Summary** The Director of Provider Network Contracting is responsible for maintaining and growing a… more
- WellSpan Health (York, PA)
- …Government Regulations Required and + Supervisory experience. Required + Healthcare reimbursement , third party payor or regulatory experience. Preferred ... new hospital additions as applicable, in accordance with System Care Contracting Team. Includes all traditional medical components (hospital, WMG, Apple Hill,… more
- Health Care Service Corporation (Albuquerque, NM)
- …for a motivated lawyer to provide counsel relating to complex contracting , including vendor, provider network, producer/customer, and strategic sourcing ... complex and evolving legal and technology environment, the ideal candidate will provide sound, actionable legal advice on regulatory , business, and operational… more
- Centene Corporation (Tallahassee, FL)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Provide legal advice and services regarding vendor contracting , including ... + Serves as a lead resource to Enterprise Procurement function regarding vendor contracting in one or more subject matter areas impacting various Centene product… more
- Molina Healthcare (Seattle, WA)
- …must live in Washington _** **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and ... Manager and/or Director in the negotiation of medical group/IPA and hospital contracting . * Advises Network Provider Contract Specialists on negotiation of… more
- Commonwealth Care Alliance (Boston, MA)
- …position partners closely with provider engagement, delegation partnerships, provider services, contracting , quality, compliance, medical management, and ... , operations, and analytics teams to monitor network performance against internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state… more
- Point32Health (RI)
- …and analysis of new reimbursement strategies and financial analytics supporting provider contracting in the Point32Health network. + Summarize findings of ... the submission of regulatory requests. + Coordinates and oversees the annual re- contracting of the provider network for commercial business. + Works with… more
- AmeriHealth Caritas (Washington, DC)
- …dual eligibility health insurance, ACA Exchange Business & DSNPs. + 5 years provider contracting / reimbursement experience in healthcare setting. + 3 years ... compliance with pricing guidelines established by AMC and Plan. + Ensures provider contracting is consistent with claim payment methodologies. + Maintains… more
- Molina Healthcare (Gulfport, MS)
- …lives in Mississippi _** **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy ... that result in high quality, cost effective and marketable providers. Contract/Re- contracting with large scale entities involving custom reimbursement . Executes… more
- Abbott (Livermore, CA)
- …**Preferred Qualifications** + Relevant experience in payor contracting and regulatory compliance at a healthcare provider , payor, or network.Minimum ... medical insurance companies) contracting and relations, preferably within the DME/IDTF provider space + Regulatory compliance and policy management in one… more
- Commonwealth Care Alliance (Boston, MA)
- …Provider Network Management staff to ensure an adequate and appropriate provider network. Participate in contracting strategy discussions around potential ... 011230 CA- Provider Engagement & Performance **Position Summary** The ...service recovery; Program benefits; Clinical initiatives; Referral and authorization; Regulatory compliance; Billing and payments; Complaints and appeals; Policies… more
- Commonwealth Care Alliance (Boston, MA)
- …providers. This individual serves as a key liaison, proactively addressing provider needs, ensuring regulatory compliance, and supporting operational excellence ... cross-functional teams (eg, Claims, Credentialing, Clinical Care Management, Member Services, Provider Services, Regulatory Affairs, Marketing) to resolve … more
- Humana (Springfield, IL)
- …authorizations & referrals). + Work with internal resources and systems (eg, claims, reimbursement , provider enrollment) to provide Exceptional Experience in ... Experience in provider operations, building strong relationships with provider organizations, financial/ contracting arrangements, and/or regulatory … more
- Magellan Health Services (Boise, ID)
- …outreach and engagement plan. Responsibilities include building and maintaining an adequate provider network to meet the needs of the member population. Monitoring ... adequacy (geo access), recruitment of new providers (sending and negotiating provider agreements), establishing and maintaining strong relationships with providers, … more
- Health Care Service Corporation (Chicago, IL)
- …or Managed Care environment, including 3 or more years of hands-on experience in Provider Contracting , Network Management, or Provider Relations + Proven ... quality performance within the contracted working relationship with the health plan. The Provider Vertical Leader works to identify the business plan and will have… more
