Contractor for Managed Care Contracting and Provider Enrollment

Feminina Group; Seattle (WA); Remote; USD 70,000 - 100,000; Full time

Job summary

A leading company in virtual women's health is seeking a Contractor for Managed Care Contracting and Provider Enrollment. The role involves developing relationships with payers and overseeing enrollment and credentialing. Ideal candidates are experienced in managed care, possess strong negotiation skills, and have a passion for women's health.

Qualifications

• 3-5 years of experience in managed care contracting and credentialing.
• Strong understanding of healthcare regulations and payer policies.
• CPCS or CPMSM credentials preferred.

Responsibilities

• Develop and maintain relationships with managed care organizations.
• Negotiate contract terms and reimbursement rates.
• Analyze contract performance and identify improvement opportunities.

Skills

Negotiation

Interpersonal Skills

Communication

Problem Solving

Attention to Detail

Education

Bachelor’s degree in Healthcare Administration

Master’s degree preferred

Tools

Credentialing software systems

Job description

Contractor for Managed Care Contracting and Provider Enrollment

Remote / Seattle, WA - contractor

Gennev is a virtual clinic offering nutrition and lifestyle care to women from reproduction to menopause.

Gennev, a Unified Women’s Health company, is a national, virtual health provider that specializes in menopause and sexual health, nutrition/lifestyle, and weight management for women. Gennev, together with Unified Women’s Healthcare has the unique opportunity to serve a woman’s healthcare needs – both virtually and in-person – throughout her life journey. If you’re driven by pioneering new approaches in health and wellness using technology and a unique integrated care model, then Gennev’s start-up culture may be for you.

Summary of Position

This contract position for Managed Care Contracting and Provider Enrollment will develop and maintain relationships with managed care organizations, insurance companies, and third-party payers, in addition to having oversight of payer enrollment and credentialling. This includes negotiating favorable contract terms and reimbursement rates with payers to maximize revenue opportunities and ensure provider satisfaction. A growth mindset will be incredibly important in creating a first-of-its kind national virtual care model that works directly with Payers, Health Plans and Employers.

Responsibilities

• Develop and maintain relationships with managed care organizations, insurance companies, and third-party payers.
• Negotiate favorable contract terms and reimbursement rates with payers to maximize revenue opportunities and ensure provider satisfaction.
• Analyze contract performance and identify opportunities for improvement or renegotiation.
• Collaborate with internal teams, including legal, finance, and operations, to review and execute managed care contracts.
• Collaborate with our physician partners and medical directors at health plans to redesign menopause coverage provisions using evidence-based guidelines.
• Oversee credentialing agency to facilitate enrollment and credentialing procedures.
• Coordinate with Clinical Operations and Clinical teams to ensure provider data is up to date to ensure timely responses.
• Ensure compliance with all relevant regulatory requirements and accreditation standards.

About You

• Experienced and comfortable in a high growth virtual health environment that often times come with ambiguity and a need for new processes.
• Strong entrepreneurial drive, comfortable in a startup environment, with a high sense of urgency and problem-solving skills that enable you to think at a strategic level yet deliver operational and administrative tasks as you collaborate across various teams.
• Conveys a high level of emotional intelligence, particularly with regards to working with physicians, clinical operations and business development teams.
• Able to connect people with the purpose and vision of the company.
• Strong written and spoken communication skills.
• Energy and passion for women’s health.

Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, or related field; Master’s degree preferred.
• Minimum of 3-5 years of experience in managed care contracting, healthcare credentialing, and provider enrollment within a telehealth or healthcare organization.
• Strong understanding of healthcare regulations, accreditation standards, and payer policies.
• Excellent negotiation, communication, and interpersonal skills.
• Proficiency in data management and credentialing software systems.
• Detail-oriented with the ability to prioritize tasks and meet deadlines in a fast-paced environment.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) credentials preferred.