Contracts Claims Manager Jobs in Raleigh, NC (NOW HIRING)

The Supervisor of Contracts and Enrollment provides day-to-day oversight of all provider enrollment and contracting functions. The Supervisor of Contracts and Enrollment works with the Manager of Provider Contracts and Enrollment to implement all unit and departmental goals, and ensure internal and external requirements for provider contracting are met.

This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.

Responsibilities & Duties

Supervise Day-to-Day Unit Operations

• Supervise day-to-day operations of the Enrollment and Contracting teams to ensure timely and accurate completion of all enrollment and contract requirements
• Ensure all enrollment and contract processes are consistent across new and existing providers
• Monitor Enrollment requests and responses to ensure compliance with internal policies and procedures
• Support and oversee the assessment of provider applications to determine eligibility status for enrollment and contract, in line with network inclusion/exclusion criteria
• Ensure provider contract set up is complete, accurate, and in alignment with all internal and external contracting requirements
• Investigate provider service discrepancies in contract details, subsequent claims issues, and/or complaints as requested and report findings
• Conduct Enrollment and Contracts quality audits
• Ensure timely responses are provided for internal and external inquiries related to enrollment/contracting

Supervise and Develop Staff

• Maintain all Contract and Enrollment desk procedures, reference materials, and workflows
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Organize workflows and communicate updates to ensure all staff understand respective roles and responsibilities
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• Cultivate and encourage efforts to expand cross-team collaboration and partnership
• Conduct team meetings and individual supervisory meetings as indicated

Collaborate with Internal Departments

• Serve as primary point of contact for escalated concerns related to a contract and/or enrollment status, including related claims issues
• Investigate all concerns related to provider contracts or enrollment
• Coordinate with internal departments to ensure provider contracting process is complete and timely, and does not negatively impact claims submission/payment

Take Lead in Special Projects

• Coordinate special projects, contract changes, or other outreaches as assigned by Manager

Minimum Requirements

Education & Experience

Required:

Bachelor’s degree from an accredited college or university in Human Services, Education, Sociology, Business, Public Administration, or related field and four (4) years of experience in community, business, or governmental programs in health-related fields.

Preferred: 

Supervisory experience in consultative, or administrative functions is preferred.

Prior experience in Managed Care setting, Provider Relations, or Provider Contracting preferred.

Knowledge, Skills, & Abilities

• General knowledge of Provider Enrollment and Contract requirements
• General healthcare and managed care knowledge
• Knowledge of database systems for contract and claims management
• Thorough knowledge of Microsoft Office Suite, particularly MS Word and MS Excel
• Knowledge of NC Tracks enrollment requirements 
• Strong interpersonal skills and ability to communicate with various staff
• Ability to problem solve
• Ability to prepare reports
• Ability to manage multiple tasks and/or projects

 Salary Range 

$69,592 - $88,729/ Annual

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity 

 An excellent fringe benefit package accompanies the salary, which includes:   

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility