Provider Relations Manager

BCforward; Tucson (AZ); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

major medical

HSA

dental

vision

employer-provided group life

voluntary life insurance

short-term disability

long-term disability

401k

Job summary

BCforward seeks a Network Support Manager to join our team in a on-site role focusing on provider network operations, facility and provider contracting, and value-based care initiatives.

The successful candidate will optimize network access, quality, compliance, and performance while driving operational execution and provider engagement across multiple lines of business and platforms.

Qualifications

• BA/BS degree and at least 3 years in healthcare with provider relations.
• Experience with provider networks, facility contracts, and reimbursement.
• Familiar with Medicare Advantage, Medicaid Managed Care, and value-based care models.
• Understanding CMS/state quality programs, risk adjustment, and utilization management.
• Excellent communication and stakeholder management.

Responsibilities

• Coordinate workflow and tactical implementation of activities to maintain facility and provider networks and contracting initiatives.
• Oversee day-to-day training, guidance, and management of department activities and resolve issues impacting facilities and providers.
• Analyze and coordinate strategies, policies, and programs to ensure accurate administration of facility and provider contracts across multiple lines of business and platforms.
• Create tools to assist with contract implementation and administration.
• Interface with providers on contractual obligations, education, and updates to provider operations manuals.
• Act as a business partner on projects ensuring accurate facility and provider reimbursement policies and procedures, including pricing, POC, OHAS HMO, OHAS II, complaints, and appeals.
• Participate in projects to improve network performance across multiple lines of business.

Skills

Medicare Advantage knowledge

CMS quality programs

Provider performance dashboards

Provider contracting

Stakeholder management

BA/BS + 3 years

Education

BA/BS degree

Job description

BCforward is currently seeking a highly motivated Provider Relations Manager for an Onsite Opportunity at Tucson, AZ and Green Valley, AZ

Position Title: Provider Relations Manager

Location: Tucson, AZ and Green Valley, AZ

Anticipated Start Date: ASAP

Please note this is the target date, and it is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration: Full Time

Job Type: Onsite

Salary Range: $80,000/Yr.- $100,000/hr.

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Job Summary:

We are seeking a Network Support Manager to join our dynamic team. The ideal candidate will have strong experience in provider network operations, facility and provider contracting, value-based care, and quality programs and a proven ability to optimize network access, quality, compliance, and performance while driving operational execution and provider engagement.

Responsibilities:

• Coordinate workflow and tactical implementation of activities to maintain facility and provider networks and contracting initiatives.
• Oversee day-to-day training, guidance, and management of department activities and resolve issues impacting facilities and providers.
• Analyze and coordinate strategies, policies, and programs to ensure accurate administration of facility and provider contracts across multiple lines of business and platforms.
• Create tools to assist with contract implementation and administration.
• Interface with providers on contractual obligations, education, and updates to provider operations manuals.
• Act as a business partner on projects ensuring accurate facility and provider reimbursement policies and procedures, including pricing, POC, OHAS HMO, OHAS II, complaints, and appeals.
• Participate in projects to improve network performance across multiple lines of business.

Required Skills & Qualifications:

• Familiarity with Medicare Advantage, Medicaid Managed Care, and value-based care models.
• Understanding of CMS and state quality programs, risk adjustment, and utilization management.
• Competency with clinical and provider performance dashboards and EHR/workflow navigation.
• Experience with provider contracting language and operational requirements.
• Excellent communication and stakeholder management abilities.
• Requires a BA/BS degree and a minimum of 3 years of experience in the healthcare industry with background in provider relations, facility contracts, and reimbursement. An equivalent combination of education and experience will be considered.

Preferred Skills:

• Experience managing multi-line provider networks and reimbursement policies and procedures.

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to:

• major medical
• HSA
• dental
• vision
• employer-provided group life
• voluntary life insurance
• short-term disability
• long-term disability
• 401k

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.