Network Operations Manager

Curative - Austin, TX

Full-time

Austin, TX

Personal and Laundry Services

About the position

The Network Operations Manager is responsible for overseeing the provider contracting process for a rapidly growing health plan. This role ensures that contracts are efficiently managed, compliant with standards, and smoothly integrated into the claims system. The manager collaborates with various departments to optimize the contracting process and leads initiatives to develop policies and procedures that enhance network development and credentialing. Additionally, the position involves risk identification, audit assistance, and maintaining compliance with regulations.

Responsibilities

• Manage the provider contracting process for a rapidly growing health plan.
• Ensure negotiators use the correct documents efficiently.
• Ensure contracts meet established standards.
• Facilitate smooth contract flow through processes and ensure Claims Operations can load contracts into the claims system.
• Collaborate with network contracting colleagues, legal department, compliance, credentialing, and claims operations to streamline the contracting process.
• Establish an end-to-end provider contract review policy and procedure, including negotiation of language and rates to entry in the claims system.
• Manage all policies and procedures impacting network development and credentialing teams, including the development of new processes.
• Lead the market fee schedule governance committee and ensure compliance with federal and state regulations.
• Own and update provider resources to comply with regulations or expansion, including 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 timely and accurate network filings, including adherence to guidelines supporting Mental Health Parity.
• Create and maintain a library of approved 'Model Contracts' for hospitals, physicians/groups, and ancillary providers.
• Reduce/eliminate rework or mitigate unfavorable contract terms over time.

Requirements

• Bachelor's degree or equivalent experience in a related field.
• 7+ years of work experience beyond degree within provider contracting and/or health insurance.
• 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 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 strong interpersonal skills.