Coordinates contracting functions and is responsible for supporting network rostering for all OneCare Vermont (OneCare) contracts. Responsible for managing the lifecycle of frequently updated files, using internal tools to process and maintain these files, often updating data that has significant visibility and impact on other teams within OneCare who rely on high-quality data to support clinical and financial reform efforts.

The Manager of Network Operations is responsible for the development and maintenance of the OneCare Vermont (OCV) participant network. The incumbent leads the operational servicing of the network, including the provider contracting and enrollment functions required by the payers. As the Network leader, the Manager is expected to oversee and direct the internal and external network team in order to provide superior service to network participants and assure compliance with network contracts.… Show more The Manager of Network Operations is responsible for the development and maintenance of the OneCare Vermont (OCV) participant network. The incumbent leads the operational servicing of the network, including the provider contracting and enrollment functions required by the payers. As the Network leader, the Manager is expected to oversee and direct the internal and external network team in order to provide superior service to network participants and assure compliance with network contracts. The Manager also serves as the primary contact for the OCV participant network when operational issues related to the contracts arise or when there are escalated complaints. Show less

The Supervisor of Provider Relations is responsible for the management of the overall day to day functions of the Provider Relations Department. The Supervisor will work closely with the Senior Network Profile Specialist regarding provider claim issues, provider profile changes, providers requesting to be contracted with VMC, and new processes to improve the service we provide our customers. Coordinates day to day contracting systems and work associated with contracting including contract… Show more The Supervisor of Provider Relations is responsible for the management of the overall day to day functions of the Provider Relations Department. The Supervisor will work closely with the Senior Network Profile Specialist regarding provider claim issues, provider profile changes, providers requesting to be contracted with VMC, and new processes to improve the service we provide our customers. Coordinates day to day contracting systems and work associated with contracting including contract assessment and analysis, contract strategy, contract development, contract implementation, monitoring and negotiations of provider contracts for VMC. Is the primary contact for the Vermont Managed Care (VMC) Network Providers and Facilities, with regard to operational, contractual, and business issues relevant to both the VMC and the Fletcher Allen Health Care (FAHC) Payer Contracts. As the liaison between the VMC Network Providers / Facilities and FAHC's Clinical Departments / Medical Staff, and the VMC and FAHC contracted insurance plans, provides superior service and advocacy on behalf of both VMC and FAHC providers while ensuring and maintaining continued collaborative working relationships between all parties. In this process, collaborative working relationships between Community Providers and FAHC are also established and fostered. This position researches all provider issues through to resolution and communicates results to the provider, payers, and VMC staff. Also responsible for the project management of various VMC business projects and initiatives. While providing daily educational meetings and seminars for the VMC Network, he/she develops and maintains education and marketing tools that include the VMC Provider Manual, the VMC "Partners in Care" Newsletter, the VMC and Fletcher Allen Preferred Web Sites, and healthcare conference and trade-show display table. Show less

Works closely with the Senior Network Profile Specialist regarding provider claim issues, provider profile changes, providers requesting to be contracted with VMC, and new processes to improve the service we provide our customers. Coordinates day to day contracting systems and work associated with contracting including contract assessment and analysis, contract strategy, contract development, contract implementation, monitoring and negotiations of provider contracts for VMC. the primary… Show more Works closely with the Senior Network Profile Specialist regarding provider claim issues, provider profile changes, providers requesting to be contracted with VMC, and new processes to improve the service we provide our customers. Coordinates day to day contracting systems and work associated with contracting including contract assessment and analysis, contract strategy, contract development, contract implementation, monitoring and negotiations of provider contracts for VMC. the primary contact for the Vermont Managed Care (VMC) Network Providers and Facilities, with regard to operational,contractual, and business issues relevant to both the VMC and the Fletcher Allen Health Care (FAHC) Payer Contracts. As the liaison between the VMC Network Providers / Facilities and FAHC's Clinical Departments / Medical Staff, and the VMC and FAHC contracted insurance plans, he/she provides superior service and advocacy on behalf of both VMC and FAHC providers while ensuring and maintaining continued collaborative working relationships between all parties. In this process, collaborative working relationships between Community Providers and FAHC are also established and fostered. This position researches all provider issues through to resolution and communicates results to the provider, payers, and VMC staff. Also responsible for the project management of various VMC business projects and initiatives. While providing daily educational meetings and seminars for the VMC Network, develops and maintains education and marketing tools that include the VMC Provider Manual, the VMC "Partners in Care" Newsletter, the VMC and Fletcher Allen Preferred Web Sites, and healthcare conference and trade-show display table. Show less

• Negotiated commercial third party payer contracts.• Completed Due Diligence of payer proposals.• Contract operational analysis to include review of payer policies and procedures.• Contracting for all available FAHC professional and facility services.• Built positive working relationships with payers.• Responsible for contract maintenance and communications, disseminate new or revised payer contract terms.• Facilitate Payer/Provider relations, attend Payer Ops meetings,… Show more • Negotiated commercial third party payer contracts.• Completed Due Diligence of payer proposals.• Contract operational analysis to include review of payer policies and procedures.• Contracting for all available FAHC professional and facility services.• Built positive working relationships with payers.• Responsible for contract maintenance and communications, disseminate new or revised payer contract terms.• Facilitate Payer/Provider relations, attend Payer Ops meetings, Problem solving, Liaison between Payer and operational staff.• Obtained Payer benefit interpretations for new services and distribute to appropriate parties.• Oversaw the implementation of new contracts or renewed contracts.• Attended monthly operational meetings with various FAHC departments.• Negotiated single case agreements for non-contracted payers.• Assisted in the resolution of issues regarding, claims, appeals and denials.• Worked closely with contracted payers Provider Relations staff.• Assigned duties as necessary to staff assistant Show less

•Worked closely with the President of CBA/EBPA•Provided geo access report information from various networks for potential sales.•Ordered Disruption reports and other various report requests. •Negotiating provide contracts.•Updating claims payment systems and the CBA/EBPA provide web site. •Provider meetings to discuss issues regarding contracts or potential contracts, billing questions or other concerns.•Contracting and re-contracting of providers and hospital… Show more •Worked closely with the President of CBA/EBPA•Provided geo access report information from various networks for potential sales.•Ordered Disruption reports and other various report requests. •Negotiating provide contracts.•Updating claims payment systems and the CBA/EBPA provide web site. •Provider meetings to discuss issues regarding contracts or potential contracts, billing questions or other concerns.•Contracting and re-contracting of providers and hospital contracts.•Liaison between providers/hospitals and provider networks and Utilization Management dept. Show less