Job Purpose

Ventegra is a fast paced, innovative virtual company. The Provider Contracting Manager’s role is to provide leadership and technical expertise to the development, maintenance, and effective operation of Ventegra’s healthcare provider network. This position will be responsible for network development activities, including generation and review of healthcare provider contract documents, negotiating contract language, rate negotiation, outreach to providers, provider dispute resolution, client services support (i.e., GeoAccess, custom network, etc.) and follow-through to contract completion. The Provider Contracting Manager will also support the credentialing and audit functions, and work with internal team members to address provider issues such as compliance, rate discrepancies and conflicts between provider relationships and client business needs.

Duties:

• Negotiate network contracts with various provider types
• Implement, analyze and maintain provider networks, network rates and applicable structures in Ventegra’s Claim System and contract database
• Credential providers to ensure compliance. Audit and maintain an accurate credentialing database.
• Prepare, analyze, review, and coordinate with other departments to effectively monitor contract and network financial and operational performance
• Develop, maintain and generate reports from network contracting database
• Maintain accuracy of provider network data by updating as appropriate in Ventegra’s various databases/systems
• Assist in resolving elevated and complex provider service issues by researching root causes, as well as negotiating and communicating with internal/external partners/customers. Assist in the development of long-term solutions to mitigate future occurrences.
• Assist with RFPs and various network reporting requests
• Initiate and maintain effective channels of communication with providers and related office staff
• Conduct quality control reviews of business processes and workflows for improvement
• Participate as a key member of cross-functional workgroups and teams
• Perform routine system audits to ensure compliance and integrity of the Ventegra Claims System
• Maintains team project management status/reports
• Performs other duties as assigned
• Minimal travel, as required

Skills/Qualifications:

• Bachelor’s Degree
• Minimum recent 5 Years’ provider medical benefit contracting language knowledge and negotiations experience required; pharmacy contracting experience a plus
• Demonstrated ability to understand and interpret contract language and negotiate favorable contract terms
• Excellent verbal and written communication skills, including the ability to gather, document, and communicate business requirements and client specifications
• Strong relationship and strategic partnering skills
• A self-starter with proven ability to manage time effectively producing a high volume of work across disparate needs that supports organizational priorities and objectives
• Ability to contribute toward a positive work environment by working well with others to achieve desired results
• Ability to understand complex and cross-functional processes and identify opportunities for improvement
• Strong problem-solving skills * Medicare billing and coding experience desirable
• Proficiency in Microsoft software required, MS Access and Excel experience desirable

About Ventegra

Ventegra is the premier, fully transparent Medical Benefits Manager (MBM) offering Pharmacy Services Administration products and services to help manage healthcare for businesses and consumers. Ventegra is committed to seeking innovative ways to channel our resources for a greater impact to improve the lives of others. Ventegra represents payors, providers, patients, and government programs.

Job Type: Full-time

Pay: $83,000.00 - $114,400.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

COVID-19 considerations:
All employees are required to be vaccinated against COVID-19.

Education:

• Bachelor's (Required)

Experience:

• Pharmacy Contracting: 1 year (Preferred)
• Provider Contracting: 3 years (Required)

Work Location: Remote

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