Provider Contract Spec Mgr (US)
- KS-TOPEKA, 120 SE 6TH AVE, STE 100, United States of America
- KS-OVERLAND PARK, 5901 COLLEGE BLVD STE 275
Location: Primarily work from home , Must be located in Kansas.
Shift: Monday-Friday,8:00am-5:00pm CST
Functions with the expertise in managing negotiated pricing loads. Responsible for coordinating the process for the most complex pricing arrangements involving facilities or large health systems, or high profile provider groups and/or physician groups tied to large hospital systems joining the network including creating standard contracts for providers as needed.
Primary duties may include, but are not limited to:
- Manage provider update files submitted by delegated provider entities and/or large groups/integrated delivery system.
- Prepare the information for timely and accurate submission to the Provider Data Management area. Ensure updates/changes for existing network providers are interpreted and loaded accurately.
- Ensure accurate and timely loading of professional and facility contracts across value based and fee for service agreements for provider solutions.
- Works directly with contracting directors and managers to understand what is negotiated and how the negotiated agreement is translated into the company's systems resulting in accurate and timely loading.
- Performs internal audit of provider record, ensuring accuracy against rosters.
- Serves as the go-to with matrix partners to resolve interpretation issues and ensure timely turnaround. Serve as local market expert supporting (and managing when necessary) the provider onboarding process and provider updates submitted by provider offices within defined market.
- Must possess critical thinking skills, have a proven strong eye for detail and a focus on quality.
Requirements:
- a H.S. diploma or equivalent and a minimum of 5 years of experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.