Job Overview
Location
Pennsylvania - Home Office
Job Type
Full-time
Category
Software Engineering
Date Posted
June 25, 2026
Full Job Description
đź“‹ Description
- • Responsible for contracting, educating, and maintaining provider networks that deliver clinical, financial, and service value to Martin’s Point Health Plan members.
- • Handle high-level contracting and renegotiations with large provider groups and PHOs across existing and future markets to ensure complex contractual obligations are met.
- • Lead contracting efforts for opening new expansion markets, including developing and executing market entry strategies.
- • Conduct provider education in-services to ensure compliance with payment policies, DOD, and CMS requirements.
- • Monitor primary care incentive payments, comprehensive visit performance, and risk-based reimbursement arrangements.
- • Attend Quarterly Health Plan Sales meetings, submit monthly recruitment reports, and present on key provider recruitment activities.
- • Manage all hospital capital requests and ensure timely processing and documentation.
- • Serve as liaison between providers and credentialing teams to ensure delegated agreements are properly executed.
- • Develop and maintain contract and reimbursement manuals to ensure consistency, accuracy, and regulatory compliance.
- • Communicate significant changes in benefits or program updates directly to providers.
- • Handle escalated provider issue management cases, including payment disputes, balance billing, and non-compliance incidents.
- • Assist with high-level audits and special contract projects as needed.
- • Train and coach new staff members, serving as a role model and resource for best practices in provider relations.
- • Travel up to 50% of the time, including overnight stays, to conduct site visits, provider meetings, and compliance audits.
- • Participate in member seminars, charity events, and other network provider activities in collaboration with the Sales Team.
- • Work closely with the Senior Network Operations Specialist and Senior Credentialing Specialist to ensure accurate and timely updates to contracting payments, language, applications, and systems.
- • Ensure provider network composition and performance meet HEDIS/NCQA standards through compliance and credentialing site visits.
🎯 Requirements
- • Bachelor’s degree or equivalent combination of education and experience
- • 5+ years of experience in provider relations and healthcare, including provider contracting with physicians, facilities, and ancillary providers
- • Valid driver’s license (no restricted or suspended license)
- • Significant proven advanced knowledge of managed care contracting and reimbursement methodologies
- • Proficiency in Microsoft Word, Excel, and Access
- • Ability to travel up to 50% of the time, including overnight stays
🏖️ Benefits
- • Work for a certified "Great Place to Work" since 2015
- • Join a not-for-profit organization with a mission-driven culture focused on caring for people
- • Collaborative, respectful organizational culture built on values of continuous learning, helping each other, and having fun
- • Equal opportunity/affirmative action employer with reasonable accommodations available
Skills & Technologies
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About Martin
Martin is a leading provider of highly engineered, mission-critical products and services for the aerospace, defense, and industrial sectors. The company specializes in complex engineering solutions, including advanced manufacturing, repair, and overhaul services. Martin's expertise spans a wide range of applications, from commercial aircraft components and defense systems to industrial gas turbines and specialized equipment. With a commitment to innovation, quality, and reliability, Martin partners with its customers to deliver customized solutions that enhance performance, extend product life, and ensure operational integrity. Their focus on cutting-edge technology and stringent quality control makes them a trusted partner for demanding industries worldwide.
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