Provider Network & Contracts Lead

Maryland-Care-Management-Inc; Linthicum (MD); On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

100% employer Term Life Insurance

Short and Long-Term Disability

401k Employer Match up to 4%

20 days PTO

Tuition assistance / professional dev.

Job summary

Maryland Care Management, Inc. (MCMI) seeks a Contract and Provider Network Analyst to evaluate contracts and apply managed care reimbursement principles to identify cost savings while maintaining quality.

You will research contracts, streamline procedures, and coordinate implementation across departments. As part of MPC's statewide network, you will monitor provider availability, review Geo Access reports, and train staff on MPC processes and benefits, contributing to efficient contract

Qualifications

• Bachelor’s degree in business, health, management systems or closely related field.
• Experience with large provider organizations, ancillary and hospital providers.
• Working experience with Geo Access or equivalent system is required.

Responsibilities

• Evaluates current contracts and applies managed care reimbursement principles to identify cost savings while maintaining quality.
• Researches contract operational procedures; coordinates with departments to streamline processes.
• Coordinates implementation of new contracts with departments involved.
• Coordinates internal review and determine administrative feasibility throughout contracting process.
• Initiates contract flow process; ensures signatures and data entry to system.
• Acts as team lead and trainer for Provider Data Coordinators.
• Ensures legal/regulatory review of contracts prior to execution.
• Monitors provider availability and accessibility to ensure network coverage.
• Creates and reviews Geo Access reports and makes recommendations for future network build-out.
• Assists with onsite contract reviews; ensures accuracy and timeliness of data in provider files.
• Assists with training providers regarding MPC processes and benefits; disseminates information as needed.

Skills

Contract review

Presenting to groups

Advanced problem solving

Organization and coordination

Geo Access data usage

Microsoft Office Suite

Education

Bachelor’s degree in business/health/management systems or related

Tools

Geo Access

Microsoft Office Suite

Job description

Maryland Care Management, Inc. (MCMI) seeks a Contract and Provider Network Analyst to evaluate contracts and apply managed care reimbursement principles to identify cost savings while maintaining quality.

You will research contracts, streamline procedures, and coordinate implementation across departments. As part of MPC's statewide network, you will monitor provider availability, review Geo Access reports, and train staff on MPC processes and benefits, contributing to efficient contract