Manager, Provider Services And Contracting

ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary

Assist in development and maintenance of a comprehensive network of long-term care, ancillary, primary care provider, specialty physician, and hospital providers for Florida Community Care/ Independent Living System programs and products. Negotiate contracts, and act as point of contact for ongoing contractual and provider service issues.

Essential Functions

1. Ability to negotiate all types of managed care contracts, including long term care, ancillary, PCP, specialist, and hospital agreements. Able to negotiate competitive reimbursement rates, and contract language changes as necessary.
2. Maintain complete and updated knowledge of managed care reimbursement methodologies, market competitive rates, and contractual structures.
3. Serve as the project manager for contract implementation: if applicable, oversee preparation and loading of contracts into computer systems. Maintain and audit provider network file and directories.
4. Monitor network adequacy and work to identify and resolve gaps with direct provider outreach and use of consultants.
5. Resolve provider service issues relating to claims, capitation, eligibility, network changes, and contract loading. In addition, initiate and coordinate credentialing of new additions to ILS.
6. Review, investigate and resolve provider service issues in conjunction with ILS internal departments. Analyze and research service care log data and claims data to develop proactive strategies to address provider issues and work with necessary departments to resolve.
7. Oversee ongoing contracting and renewal of providers with Director of Provider Services. Support evaluation and modification of provider network to ensure plan performance and growth.
8. Work closely with Provider Relation Account Executives to identify and facilitate resolution of issues and provider concerns.
9. Participate in the SCL process to support the provider call center in resolving provider identified issues.
10. Coordinate with ILS’ Correspondence Team the monthly provider complaint report for submission to AHCA; and trend and track complaints and SCLs to determine strategies to improve provider relations.
11. Other duties as assigned.

Education and Experience

• Bachelor's Degree and at least three (3) years of provider contracting experience.
• Proficiency of Microsoft Office applications including Office, Excel, and Outlook.

Required Skills

• Ability to Lead team(s), motivate others and engage others at all levels.
• Formal presentation skills required.
• Ability to analyze complete concepts including Provider Reimbursement methodologies, reports, etc. and provide resolution within required timeframes.
• Effective Highly organized and self-motivated.
• Capable of working independently.
• Ability to interact with people of all ages and cultural backgrounds.

EEO STATEMENT

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.