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Manager, Provider Network Management - Government Division - Remote
About Thriveworks
Thriveworks is a leading mental health provider with over 380 locations across the US, 2,000 clinicians, and a robust virtual counseling business serving hundreds of thousands of clients. Our mission is to help people live happy and successful lives by making high-quality counseling and psychiatry services accessible and affordable. We believe that everyone can benefit from working with a skilled therapist, and counselor, and strive to ensure that people all across the country have that very opportunity. Thriveworks' licensed clinicians are in-network with major insurance plans and provide in-person and online care for depression, anxiety, trauma, stress, relationship issues, and more.
About the Job
The ideal candidate will be comfortable in a fast-paced, innovative, growing environment. You will be presented with multiple competing tasks, and no day will be the same. You will be required to bring ideas to the table and execute successfully at a rapid pace. This candidate would support the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide healthcare services to low-income, uninsured, and other populations.
Key Responsibilities
- Responsible for supporting the negotiation, oversight, monitoring, and management of regulatory and contractual requirements related to government programs including, but not limited to, Medicaid, Medicare, duals (MMP), and Marketplace.
- Supports Director in responses to internal informational requests and contract interpretations.
- Perform and/or arrange for legal language review on all government program contracts before execution.
- Support implementation of new government contracts with appropriate internal departments.
- Works with Billing and other internal departments to resolve payment and utilization issues.
- Support and educate other staff regarding the interpretation, compliance, and enforcement of the contractual provisions.
- Generate reimbursement modeling reports and workbooks.
- Review reimbursement opportunities and engaging in follow-on negotiations
- Develop responses to state agencies as required for Medicaid and Marketplace product lines and coordinates the filing process for the Marketplace line of business
- Develops, maintains, and updates regulatory work plans, including state regulatory guidance documents and state rules. Educates internal staff on changes to regulatory contracts
Skills & Qualifications
- Must have multi-state or multi-site healthcare payor strategy experience
- Strong provider/payor contract negotiation experience
- High degree of professionalism and the ability to communicate with a variety of stakeholders, including clinical team members
- Proficient understanding of credentialing/provider enrollment functions and processes
- Working knowledge of contract management, contracting concepts, and demonstrated knowledge and ability in negotiations, contract principles, and interpretation of contract language
- Experience working with large sets of data, formula writing, pivot tables, etc.
- Strong verbal and written communication skills
- Maintains confidentiality of all patient and payor information
- Strong quantitative and analytical skills
- Detail-oriented with strong organizational skills
- Ability to multi-task and manage competing priorities
Requirements
- Must have strong business management background
- Bachelor's degree is required
- 3-5 years of experience working in commercial health care/managed care
Benefits
- An amazing team culture
- Professional development & advancement opportunities
- 401K with a 3% employer match
- Healthcare, Dental, Vision, and life insurance benefits
- Paid time off and paid holidays
- Professional EAP program for team members & household
- Additional coverage options available such as Short Term Disability, Long Term Disability, Group Accident Insurance
Successful Thriveworks employees believe in our mission to help people live happy, healthy lives. They also embody our core values, which focus on the ability and willingness to adapt, raise the bar, act with integrity, achieve our goals, and work well together. If you think you fit the bill and belong on our team, apply today!
Physical demands for Thriveworks positions may include being sedentary for long periods of time. Entering text or data into a computer by means of a traditional keyboard is also a requirement.
#LI-Remote #LI-NH2
Interested in joining Team Thriveworks? We're thrilled to meet you!
With job scams becoming more and more frequent, here's how to know you're speaking with a real member of our team:
- Our recruiters and other team members will only email you from an "@thriveworks.com" email address.
- Our interviews will take place over Google Meet (not Microsoft Teams or Zoom).
- We will never ask you to purchase or send us equipment.
If you see a job scam related to Thriveworks, please report to infosec@thriveworks.com. You can contact employment@thriveworks.com with any questions or concerns.
Thriveworks is an Equal Opportunity Employer. Our people are our most valuable assets. We embrace and encourage differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other characteristics that make our employees unique. We encourage and welcome diverse candidates to apply for any position you are qualified for to bring your unique perspective to our team.
