Senior Contract Manager

Company: Network Health
Location: Menasha
Posted on: February 15, 2025

Job Description:

DescriptionNetwork Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Senior Contract Manager to seek, maintain and service contracted relationships with Network Health HMO/POS network providers, Network Health self funded employers which provide the highest value (quality, cost and satisfaction) to Network Health plan members, Network Health providers, and internal customers. The Senior Contract Manager will also act as a team lead for the contracting department.
Duties:

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• Successfully manages the Managed Care Contracting prospective, renewal and termination negotiation proceses as they relate to: Network Health, HMO/POS; third party administrators and self-funded employers, Accountable Care Organizations (ACO).
  
• Accountable for establishing and maintaining positive relationships with internal departments, Network Health executive leadership and for any of the folowing prospective and/or existing external group: Network Health HMO/POS and third party administrators
  
• Serves as the individual accountable for the overall relationship between Network Health and selected contracted providers. Specific duties include establishing the initial contact with contracted providers setting and/or maintaining the tone for the desired Network Health provider agreements.
  
• Conducts managed care contracting related research and analysis including developing compensation/reimbursement structures and contract terms/conditions. Evaluates best-fit options for continued negotiations. Prepares executive summaries and recommendations.
  
• Initiates contract implementation process. Maintains effective communication throughout contract terms and communicates contract updates and changes as needed. Requests audits from the Provider File Specialist and evaluates contracting terms.
  
• Works with Director and VP of the Department on more complex, large system Provider Contracts.
  
• Trains and develops other Contract Managers as needed
  
• Serves as department leader in absence of the Director of Provider Contracting,
  
• Handles and leads Network Health special Provider contracting projects.
  
  Requirements:
  
  • 
    
  • Bachelors degree in a related field or eight years of equivalent experience.
    
  • Minimum of six years of experience in the health care industry (hospital, health insurance, or physician practice).
    
  • Minimum of four years health services negotiation and provider/customer service experience, preferably health insurance and/or provider
    
    
    
    Skills:
    

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    • Advanced health care financial, reimbursement and utilization data and analysis skills.
      
    • Working knowledge of medical terminology, health care billing/coding, reimbursement and insurance benefit methodologies.
      
    • Exceptional customer service/relationship management skills.
      
    • Ability to prioritize multiple tasks and projects.
      
    • Self-guided and motivated to achieve deliverables in a timely fashion
      
      We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.
      
      

Keywords: Network Health, Appleton , Senior Contract Manager, Executive , Menasha, Wisconsin