Client Relationship Manager

Duration: 12 Months Contract – To – Hire

Location: Harrisburg / Pittsburgh PA

Job Description:

• Responsible for development and management of provider networks for all products: Medicaid, and Medicare.

• Responsible for hospital and physician network development and management.

• Develops and recommends policy changes related to provider recruitment and contracting.

• Recruits and negotiates contracts with specific providers within operational and potential new counties to meet company requirements.

• Oversees training and communication for network providers and acts as a liaison with the provider community.

• Ensures compliance with pricing guidelines established by AMFC and Plan. 

• Ensures provider contracting is consistent with claim payment methodologies.

• Maintains familiarity with Medicare and State Medicaid fee schedules and reimbursement methodologies and analyzes comparable Plan pricing guidelines.

• Resolves difficult complex contract issues to ensure that provider contracts are in compliance with state, federal, national accrediting agencies and Plan contracting guidelines.

• Ensures that non-standard contract elements are communicated to appropriate departments and obtains AMFC and Plan approval prior to submission to provider.

• Responsible for the accuracy and timely management of all provider contracts.

• Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims.

• Responsible for achievement of quality and health plan objectives through accomplishment of provider initiatives