[ref. a73270502] Network Operations Manager
Curative HR LLC Austin Full-time
Responsibilities
- Manage the provider contracting process for a rapidly growing health plan, including
- Assuring that negotiators are efficient in their use of the correct documents
- Assuring that contracts are meeting standards
- Assuring contracts flow smoothly through the processes and that Claims
- Collaborate with network contracting colleagues, as well as legal department, compliance, credentialing and claim operations to optimize and streamline the contracting process.
- Establish an end-to-end provider contract review policy and procedure incorporating the negotiation of language and rates to the entry in the claim system
- Manage all policies and procedures impacting the network development and credentialing teams; including development of new processes
- Lead the market fee schedule governance committee and ensure compliance with federal and state regulations
- Own and update the provider resources, as needed, to comply with regulations or expansion; including but not limited to the Provider Manual
- Identify potential risks associated with contracting activities and propose mitigation strategies
- Assist with internal and external audits
- Partner with Compliance to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity
- Create and maintain a library of approved “Model Contracts” for hospitals, physicians/group, and ancillary providers
- Reduce/eliminate rework or mitigation of unfavorable contract terms over time
- Bachelor’s degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insurance
- Remote with occasional travel (5%)
- 7+ years of experience with health plan or provider organizations
- Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
- Experience with physician group and ancillary provider contracting language and reimbursement
- Experience reviewing delegated credentialing agreements
- Demonstrated experience in seeking out, building and nurturing strong internal and external relationships
- Team player with proven ability to develop strong working relationships within a fast-paced organization
- Customer centric and interpersonal skills are required.
Samsung SDS AmericaAustin
Operations Team.
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As a Lead Network Engineer, you will play a critical role as the point of contact for SDSA network operations team for the brand-new state-of-the-art semiconductor fab in Taylor, TX. In this role, besides some management...
Austin
and access points, as well as network services such as DNS, DHCP, and VLANs.
• Monitor video network performance, troubleshoot issues, and implement solutions to ensure the smooth operation of our network resources.
• Maintain accurate documentation...
Samsung SDS AmericaTaylor (TX), 43 mi from Austin
Operations Team.
Position Summary:
As a Senior Network Engineer, you will play a critical role in supporting, managing, and implementing network projects while resolving complex technical challenges. This position requires a deep understanding of routing...