This site uses cookies. To find out more, see our Cookies Policy

Provider Contracting Manager in Orange at Prospect Medical Systems

Date Posted: 9/21/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Experience:
    Not Specified
  • Date Posted:
    9/21/2018
  • Job ID:
    10669

Job Description



Provider Contracting Manager

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Provider Contracting Manager provides guidance to staff in identifying network needs to negotiate Memorandums of Understanding (MOUs) and contracts with providers to ensure availability and accessibility to members



Job Responsibilities/Duties

  • Review CDA to ensure executed contracts and amendments are accurately entered.
  • Audit Contracting drives Scanned Contracts folder and MOU folders to verify newly executed contracts and MOUs are scanned.
  • Monitor the daily Pended Contracting reports to ensure turn-around-times are being met.
  • Audit Contracting drives Scanned Contracts folder and MOU folders to verify newly executed contracts and MOUs are scanned.
  • Maintain assigned networks by reviewing provider panels and identifying network needs, fills network gaps by negotiating contracts and MOUs with providers.
  • Oversee follow up for return of signed contracts, amendments and/or credentialing applications.
  • As needed negotiate MOUs for claims and referrals on Pended Contracting daily reports, urgent requests from Medical Management, Provider Dispute Resolutions and Member balance bill issues.


Qualifications

Minimum Education:  Bachelor’s degree required.

Minimum Experience: Three ( 3) years of contracting experience related to healthcare. Sales and negotiation experience.  Supervisor and Managerial experience.

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit   http://pmh.com/careers/  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm



10669

CHECK OUT OUR SIMILAR JOBS

  1. Care Manager Jobs
  2. Program Manager Jobs