Provider Contracting Manager

Zing Health Holdings Inc; Illinois; On-site; USD 90,000 - 130,000; Full time

Job summary

Zing Health Holdings Inc is seeking a Sr. Network Manager to lead provider contracting and network development across all lines of business in Illinois.

The role emphasizes cost-effective network strategy and collaboration with Sales, Marketing, and Health Services to support market growth and medical cost targets. Responsibilities include negotiating with hospitals and physicians, conducting provider orientations, and managing relationships to ensure a functional network.

Qualifications

• 3–5 years of experience in a Managed Care environment, Network Management or Provider Services.
• Experience in hospital contracting or related network management positions.
• Demonstrated negotiation, analytic and problem-solving skills.
• Experience or knowledge of provider reimbursement methods and claims processing systems.
• Verbal and written communications skills; ability to manage multiple priorities.

Responsibilities

• Contracts and negotiates with Hospitals, FQHCs, Physicians and Ancillary providers for all product lines.
• Conducts Provider Orientations and ongoing education to Network Providers.
• Understands and explains fee-for-service and risk contracts.
• Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
• Responds to provider contract requests and inquiries.
• Analyzes network gaps and identifies providers to contract.
• Reviews and amends provider contracts when necessary.
• Evaluates contracted network to ensure functionality.
• Research and develop relationships with non-contracted providers.
• Collects credentialing and required documents for newly contracted providers.
• Performs special projects as assigned.

Skills

Negotiation

Analytical skills

Problem-solving

Communication skills

Independent work

Multi-tasking

Provider relations

Job description

Description

COMPANY OVERVIEW

Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit

POSITION OVERVIEW

The Sr. Network Manager will manage provider contracting and network development for all lines of business. The Sr. Network Manager is responsible for developing, executing, and maintaining a provider network strategy. Continuously evaluates network to ensure cost effective, optimal functionality. Works in concert with Sales & Marketing and Health Services in developing actions to meet market growth and medical cost targets.

ESSENTIAL POSITION RESPONSIBILITIES

• Contracts and negotiates with Hospital, FQHCs, Physicians and Ancillary providers for all product lines
• Conducts Provider Orientations and ongoing education to Network Providers
• Understands and explains fee-for-service and risk contracts
• Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area
• Responds to provider’s contract requests and inquiries
• Analyzes network gaps and identifies providers to contract
• Reviews and amends provider’s contracts when necessary
• Evaluates contracted network to ensure functionality
• Research and develop relationships with non-contracted providers
• Collects credentialing and required documents for newly contracted providers
• Performs special projects as assigned

Requirements

POSITION QUALIFICATIONS

Required Qualifications

Education/Experience:

• Medicare Experience Preferred
• 3 - 5 years of experience in a Managed Care environment, Network Management or Provider Services
• Hospital contracting experience or related Network Management position with the ability to perform the level of duties of the position
• Demonstrated negotiation, analytic, and problem-solving skills
• Experience or knowledge of provider reimbursement methods and claims processing systems
• Verbal and written communications skills to include interpersonal and presentation skills
• Ability to work effectively and independently. Demonstrated ability to effectively manage multiple priorities

HC70-20-106