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Medlogix · 6 hours ago

Ancillary Contract Manager- Remote in NJ

United States

Full-time

Remote

Mid, Senior Level

$60K/yr - $65K/yr

5+ years exp

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of their technology and skilled staff. This position is responsible for the overall development and maintenance of ancillary and facility PPO network contracts, requiring strong negotiation skills and an understanding of healthcare contracting and compliance.

BillingHealth InsuranceInsuranceInsurTechMedical

Responsibilities

Duties include establishing targets for recruitment, rate negotiations, contract language negotiations, establishing and maintaining relationships, provider education, in person visits and follow-up

In conjunction with Network Operations Management, develops strategy for network expansion and maintenance through analysis and market knowledge to ensure the network is adequate, cost-effective and meets strategic goals

Identifies network needs in both new and existing service areas, investigate options, targets and recruits

Initiate contact with potential facilities/ancillary providers. Obtain information necessary to determine quality and rate appropriateness for addition to the network

Assist Appeals department by acting as liaison between ancillary/facility and appeal department to achieve favorable outcomes of member related issues, complaints, reimbursement or other billing issues. Determines root cause of issues, corrects and educates provider and/or staff

Represents CHN PPO externally delivering a professional and polished image and demonstrates professional and ethical business practices

Visits/meets with ancillaries/facilities regularly to educate and establish effective working relationships

Negotiate rates and contract language for overall execution

Negotiate payment and secure single case agreements for ancillary/facility bills as needed and for pre‑treatment services upon request from clinical staff

Assist with facilitating the credentialing and recredentialing process for each facility/ancillary provider

Renegotiate/renew existing contracts using analysis of cost and utilization data, gaps in service and quality reports to ensure network adequacy at efficient pricing

Assist with the development of Request for Proposals, contract updates, new product implementation and new reimbursement methodologies

Assist in preparation of updating Provider/Facility Manual

Supports the activities of the Client Services and Sales teams - attend client meetings as necessary to discuss PPO strategy, philosophy and education

Qualification

Healthcare contractingProvider recruitmentNegotiation skillsReimbursement methodologiesOrganizational skillsMS OutlookMS WordMS ExcelVerbal communicationWritten communicationTeamworkSelf-motivated

Required

Minimum of five years' experience in health care; including a minimum of three years in provider/payor contracting

Candidates must have knowledge of the hospital, ancillary and physician communities and experience interacting with providers in practice or a managed care organization

Must have knowledge of provider recruitment and contracting, and reimbursement methodologies for providers, ancillaries and hospitals

Must have excellent verbal, written and organizational skills, working knowledge of MS Outlook, Word, Excel, and a valid driver's license

Must be self-motivating and have the ability to work independently and within a team

Bachelor's degree in health care administration, business or an equivalent combination of education and work experience in managed care or health care required