Senior Manager, Provider Network Management - Remote

About Thriveworks
Our mission at Thriveworks is to help people live happy, successful lives. We believe that everyone can benefit from working with a skilled and caring mental health professional. That’s why Thriveworks was founded to help those seeking counseling or coaching gain access to truly exceptional providers.

About the Job

The ideal candidate will be comfortable in a fast-paced, innovative, growing environment. You will be presented with multiple competing tasks, and no day will be the same. You will be required to bring ideas to the table and execute them successfully at a rapid pace. This candidate will work directly with the Director, Provider Network Management to expand contracts with Commercial, State, and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide healthcare services to low-income, uninsured, and other populations and serve as the primary point of contact for these payor relationships.

• Responsible for negotiation, implementation, and management of contracts with Commercial, State, and/or Federal government programs including, but not limited to Medicaid, Medicare, duals (MMP), and Marketplace.
• Responsible as a primary point of contact with payors to negotiate financial and legal terms to include quality incentives and value-based arrangements.
• Build collaborative relationships with payors through joint operating forums, negotiation of new partnerships, and the management of existing payor relationships.
• Supports the implementation of new contracts with appropriate internal departments and management of regulatory and contractual requirements related to government programs.
• Serves as primary internal contact for informational requests and contract interpretations for assigned territory.
• Works with Billing and other internal departments to resolve moderate to complex payment and utilization issues.
• Analyzes the impact of contract proposals.
• Assist in the identification and sourcing of partners for value-based arrangements.

Skills & Qualifications

• Must have multi-state or multi-site healthcare payor strategy experience in all lines of business - Commercial, Medicaid, and Medicare Advantage.
• Demonstrated provider/payor contract negotiation skills, as well as knowledge and experience in the interpretation of contract language and compliance.
• Experience working in the managed care industry with health plans in all lines of business. 
• High degree of professionalism and the ability to communicate with a variety of stakeholders, including clinical team members.
• Experience working with large sets of data, formula writing, pivot tables, etc
• Strong quantitative and analytical skills.
• Ability to independently interpret and resolve complex issues, multi-task and manage competing priorities.
• Proficient understanding of credentialing/provider enrollment functions and processes.
• Working knowledge of RCM and credentialing functions and processes.
• Strong verbal and written communication skills.
• Maintains confidentiality of all patient and payor information.
• Detail-oriented with strong organizational skills.

Requirements

• Bachelor's Degree is required
• Master’s Degree preferred. 
• At least 7-10 years of experience in payor contracting/negotiation
• Proven ability to work with a diverse group of people, including clinicians, support staff, coworkers, and management

Job Type: 

• Full-time, fully remote, Monday - Friday

 Benefits

• 401K with a 3% employer match
• Healthcare, Dental, Vision, and life insurance benefits
• Paid time off and paid holidays
• Professional EAP program for team members & household
• Additional coverage options available such as Short Term Disability, Long Term Disability, Group Accident Insurance
• Professional development & advancement opportunities

Successful Thriveworks employees believe in our mission to help people live happy, healthy lives. They also embody our core values, which focus on the ability and willingness to adapt, raise the bar, act with integrity, achieve our goals, and work well together. If you think you fit the bill and belong on our team, apply today!

Physical demands for Thriveworks positions may include being sedentary for long periods of time. Entering text or data into a computer by means of a traditional keyboard is also a requirement. 

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