Health Care

applicants

MANAGER, Contract ImplementationManage and oversee the implementation of all provider contracts.  Perform random audits of provider setup within the provider information system (AMISYS) to ensure accurate contract implementation and subsequent claims processing. Ensure accurate contract implementation and subsequent claims processing thru activities like provider setup UAT testing etc.  Manage the health plan’s workflow to assure timely accurate submission and implementation of contracts.  Develop communicate implement and maintain production and quality standards for staff such as Contract Implementation Specialists and other staff as assigned.  Act as health plan interface on software product upgrades/implementations which affect contract implementation.  Monitor track and communicate state changes in reimbursement or benefits to responsible parties.  Act as the health plan interface with Corporate Contracting and other business owners as applicable for all questions regarding implementation and claims accuracy issues.  Document and report deviations as well as coordinate the business process of such deviations from contract standards ensuring that they have appropriate approval and can be effectively administered prior to execution.  Conduct internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation.EXPERIENCE REQUIRED:Requires a bachelors degree in a related area or equivalent experience and 5-8 years of experience in provider relations/services provider contracting.  Must have exp with AMYSIS. ABOUT THE COMPANY:Our client is one of America’s premiere managed medicaid companies.  You’ll enjoy a comprehensive benefits program, very competitive salary OUR FIRM:Health Career Professionals, LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract, interim, and permanent positions.*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.