Coordinates work flow and tactical implementation of various activities related to maintaining facility, provider network and contracting initiatives.
Participates in projects designed to improve all levels of network performance, which may include multiple lines of business.
Primary duties may include, but are not limited to: May oversee the day to day training, guidance and management of department activities and facilitates resolution of problems and issues.
Analyzes and coordinates strategies, policies and programs to ensure accurate administration of facility provider contracts across multiple lines of business and multiple platforms.
Creates tools to assist contract implementation and administration.
Interfaces with providers on contractual obligations, education, and provider operations manual updates. Coordinates and acts as a business partner on projects that ensures accurate facility and provider reimbursement policy and procedures, such as pricing, POC, OHAS HMO AND OHAS II, complaints and appeals etc.