Career Center

JOB SUMMARY:
Serves as the point of contact for Third Party Administration (TPA) services provided to key clients and the relations manager for key subcontractors/delegated entities.

Negotiates or assists the Director of Network Administration with TPA service and delegated entities contracts and/or related downstream provider agreements. As needed, collaborates with internal departments such as Compliance, Contracting, Provider Services, Configuration, Claims, Finance, Analytics, Legal Affairs, Medical Affairs, and Purchasing to ensure input into TPA services and delegated entities contracts prior to execution for optimal administrative efficiency, as well as accurate implementation and on-going reporting. Accountable for maintaining the relationship with TPA clients and delegated entities, ensuring contract compliance and resolution of various issues related to services, which may include, but are not limited to claims payment, invoice generation and payment receipt, provider access & availability, member/provider complaints and data reporting.


MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure:
   • Bachelor's Degree required.
   • Four (4) years of equivalent work experience may substitute for degree requirement.
2. Work Experience (Years and Area):
   • Seven (7) plus years in healthcare with at least Five (5) years of experience in Managed Care contracting, Provider Relations, or Third-Party Administration relations.
3. Equipment Operated:
   • PC, Phone, Fax, Scanner

SPECIAL REQUIREMENTS:
1. Communication Skills:
Above Average Verbal (Heavy Public Contact)
Writing/composing Correspondence Reports
2. Other Skills:
Analytical
Mathematics
Medical Terminology
P.C.
Research
Statistical
Word Processing
3. Work Schedule: Flexible