Provider Contract Networking Supervisor

Company: Insight Global
Location: Renton
Posted on: June 24, 2022

Job Description:

The Contract Network Supervisor is responsible for the continued development and implementation of the Network Management Plan per URAC and DoD guidelines. Understands the attitudes and values of the community and establishes effective working relationships with stakeholders to increase resources and collaboration Responsible for assuring providers and network members are educated in Health Plan criteria and processes and acts as the primary resource for orientation and coaching for performance improvement. Responsible for a key role in provider contracting and network relations. Acts as a representative and spokesperson for US Family Health Plan both internally and externally. Maintains ongoing contact with providers through on-site visits, phone and written communications. Communicate effectively with internal constituents on reimbursement strategies, mechanisms to improve payer compliance, and to communicate status and outcomes of negotiations. Utilizes knowledge of the medical community to source medical groups for the USFHP network. Evaluates the appropriate medical groups, and makes recommendations to management about which groups to include. Leads contact negotiations and completes the contracting process with new network providers and assures the successful implementation of negotiated contracts. Responsible for the Health Plans non-clinical utilization management program referral management, and providing education and oversight to the clinic based referral coordinators. Communicate effectively with internal constituents on reimbursement strategies, mechanisms to improve payer compliance, and to communicate status and outcomes of negotiations.- BA Degree in related field- Ambulatory Medicine- Project Management/Account Management- 3+ years of federal health plan contract knowledge (medicare, medicaid, TriCare, DOD, URAC etc)- Strong personality (outgoing and relationship focused)- Extensive experience understanding contracted networks and government health plans- High School Diploma or GED Required

Keywords: Insight Global, Renton , Provider Contract Networking Supervisor, Other , Renton, Washington