Medica · 3 months ago
Manager, Provider Contracting (St. Louis, MO)
St Louis, Missouri, United States
Full-time
Onsite
Mid, Senior Level
$98K/yr - $148K/yr
5+ years expMedica is a nonprofit health plan serving communities in multiple states, and they are seeking a Manager of Provider Contracting. This role involves leading a team to negotiate and manage contracts with health insurance plans, ensuring financial health and regulatory compliance while fostering provider relationships.
Health CareMedical
No H1B
Responsibilities
Mentor and manage a team of contract managers, guiding them through complex negotiations and ensuring they meet performance goals and deadlines
Lead and support contract negotiations with health plans to secure favorable terms that support the organization's financial and strategic objectives
Oversee the entire contract lifecycle from initiation, creation, and negotiation to execution, monitoring, and renewal/termination
Ensure all contracts and processes comply with federal, state, and industry standards and legal requirements
Analyze contract performance, monitor key financial metrics like reimbursement rates, and make recommendations for improvement
Foster and maintain strategic relationships with provider partners
Develop and maintain policies, procedures, and templates for contracting. Identify opportunities for internal process improvement and implement new provider programs or payment models
Liaise with other departments, such as billing, legal, and operations, to ensure accurate implementation and understanding of contract terms
Qualification
Required
Bachelor's degree in Healthcare, Finance, or Economics, or equivalent experience in related field
5 years of work experience beyond degree in contract negotiations and healthcare
Proven track record as a team leader with staff management skills
Excellent communication (written, verbal and presentation) skills
Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that's conveyed
A proven track record as a successful contract negotiator for health care services, provider or health plan
Flexibility and creativity in developing effective contracting terms
Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics
Demonstrated understanding of complex financial arrangements and quality programs across health care products
Strong financial, analytical and problem solving skills, and understanding of legal documents
Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option
An understanding and appreciation for standardizing processes to generate efficiencies and improve service levels
Benefits
Competitive medical
Dental
Vision
PTO
Holidays
Paid volunteer time off
401K contributions
Caregiver services
Many other benefits to support our employees
Company
Medica
Medica is a company that provides health coverage to meet customers needs for health plan.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
John Naylor
President and CEO
Jeni Alm
Vice President, Provider Partnerships and Solutions
Recent News
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