Irvine, California
Provider Network Contract Manager Job Opening in Irvine, California - Headquartered in Irvine, CA, Western Growers is a multi-faceted service organization and trade association founded in 1926 that operates a number of companies that offer a wide array of products and services to our member companies and other customers.
We operate as one of the largest multiple employer trust plans in the nation ( Western Growers Assurance Trust ), a Third Party Administrator ( Pinnacle Claims Management ), a Pharmacy Benefit Manager ( Pinnacle RX Solutions ), a full-service Insurance Brokerage ( Western Growers Insurance Services ), and finally as a Financial Services company ( Western Growers Financial Services ). Visit and watch this video to better understand /UcP79T2tRxQ our family of companies.
We rewarded nicely with an extensive benefits package that includes a highly competitive compensation, a wide selection of company-paid health benefits, vacation and holiday paid time off and an excellent 401K program, which includes a company match of up to 3% your contribution and profit sharing up to 7%. We also provide an education reimbursement program and career path for those seeking advancement, on-site auto detailing, dry cleaning, and more to free up some of your weekend time.
The Provider Contractor Manager is responsible for the development and negotiation of Preferred Provider Organization (PPO) & Exclusive Provider Organizations (EPO) provider contracts with healthcare providers for medical and dental services. You will also analyze and maintain internal cost containment programs for Western Growers Assurance Trust & Pinnacle Claims Management Inc and be responsible for updating and distributing all materials relevant to Cost Containment Programs on a regular basis.
What you get to do:
Negotiation and maintenance of third party contracts with outside PPO/EPO network vendors as necessary to facilitate the needs of our members and health benefit plans;
Research and analyze provider fees using system generated data as well as outside data to determine discounted fee schedules designed within the organization?s mission statement and designated goals;
Implement new contracts within the designated entity of the organization through written procedures and training of appropriate personnel in each area of the organization i.e. customer service, claims, sales, underwriting, utilization review, field office personnel, account management & service representatives;
Coordinate and implement the installation of new provider contracts with each provider office and their staff, including written procedures for billing, eligibility verification and other contractual requirements;
Essentials:
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 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;
Detail oriented with strong analytical and mathematical skills
Effective project management skills and the ability to manage multiple projects at one time;
Possess strong communication, presentation and interpersonal skills;
Ability to work overtime based on department?s needs;
Ability to travel on a moderate basis (approximately 25%).
Job Type: Full-time
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