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Manager of Provider Contracting and Configuration

Manager of Provider Contracting and Configuration

Avera Health Plans is seeking a Manager of Provider Contracting and Configuration. This individual is responsible for managing all aspects of provider contracting, provider credentialing, value based purchasing initiatives and leading provider configuration. The Manager is responsible for the management of the provider configuration and provider contracting staff. This team is responsible for the compliance of the plan in matters related to provider contracting and configuration.

The Manager will work in conjunction with product line directors, identifying shared priorities and timelines for which cross-functional teams will be held accountable. The Manager is responsible for executing and managing contracts with physician practices, hospitals, other health care providers, and vendors. The Manager is responsible for the integrity of provider set up and payment within the core systems and is responsible for addressing day to day operations issues regarding provider set up and payment.

ESSENTIAL FUNCTIONS
1. Delivers a broad, stable and high-performing network to customers.
2. Manages the contracting efforts that directly impact financial and quality performance of the network consistent with the strategic plan and the Avera Health Insurance Division’s business objectives; leveraging deep understanding of financial terms, contracting requirements and quality and trend performance.
3. Business content expert for the value based purchasing agenda of the Plans.
4. Ensures provider services staff work efforts are aligned with product line goals and objectives.
5. Functionally responsible for provider set up in all core systems and is responsible for the integrity of provider configurations including the set up and configurations of extended networks. Responsible for address the day to day operations issues regarding provider set up and payment.
6. Ensures the core system is set up to comply with provider agreements, Avera Health Insurance Division’s policies, business standards and regulatory guidelines.
7. Develops and manages the creation and execution of all Avera Health Plans and DAKOTACARE provider services policies and work instructions. Provides constructive input on the creation and execution of Avera Health Insurance Division policies that affect the provider network.
8. Provides input into the provider communication strategy that supports provider compliance with Avera Health Plans and DAKOTACARE’s policies, coding, e-commerce, billing and reimbursement instruction.
9. Builds and maintains strong, respectful professional relationships with providers and Avera Health Insurance Division team members.
10. Manages the activities related to the contract load process; manages the contract audit process to assure accurate provider set up and claims adjudication.
11. Directs the hiring, staffing, scheduling and performance of provider contracting and configuration team and manages the budget for contracting and configuration.

Time:  Full time
Salary:  Salary
Category:  Network management

Updated: 7/11/2022 11:25:28 AM

Job Contact:
Greg Jasmer
605-504-2166

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5300 S Broadband Ln
Sioux Falls, SD 57108

605-504-2166