Provider Network Manager

Western Growers Association

Provider Network Manager
As a Provider Network Manager you will be responsible for the management of the contracting and network management activities to ensure superior access to the highest quality, cost-effective Providers of healthcare services for our Members and competitiveness in the marketplace for the company. You can also look forward to:
Negotiating and building a stable Provider network that achieves objectives for unit cost performance & trend management and produces an affordable & predictable healthcare insurance product.
Evaluating and negotiating contracts with healthcare Providers in compliance with contract templates, reimbursement structure standards, and other key process controls.
Collaborating with various cross-functional departments within the organization, such as Installation, Claims, Sales, Underwriting, Utilization Management, Account Managers, etc. to ensure the timely & accurate implementation of new contracts.
Coordinating and implementing the installation of new Provider contracts with each Provider office and their staff, including written procedures for billing, eligibility verification and other contractual requirements.
Researching and analyzing Provider fees using system generated data as well as outside data to determine discounted fee schedules.
Maintaining necessary system generated fee schedules and other exhibits required as part of each agreement with the health care Provider on the health care processing system (HCPS).
Assisting in resolving elevating and complex Provider complaints and/or escalated issues with internal/external partners/customers.

Requirements:

Bachelor’s degree in Business, Healthcare or similar field preferred and/or five years of experience in Provider contract components, fee schedule determination, credentialing, claims processing and pricing;
Exceptional in-depth healthcare/insurance knowledge for medical and dental Provider relations and operations;
Knowledge of Provider fee schedule developments in DRG, CPT, CDT, RBRVS and HCPCS;
Advanced computer software skills in word processing, spreadsheet and database management;
Possess a high attention to detail with strong analytical and mathematical skills;
Effective project management skills and the ability to manage multiple projects at one time;
Verifiable, clean DMV Record and the ability to travel to locations throughout the US (mainly California and Arizona) and approximately 30% travel time.
Send resume to Lola da Silva, ****************

Thank you for your interest in employment with Western Growers. At this time, we are not accepting any third-party vendors.
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