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SCAN

Contracting Systems Manager - Health Plan

RemoteUnited States only
Published
Role
Product
Experience
Senior
Employment
Full-time
Company size
Enterprise
$92.4k–$133.7k/yr
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Open to US only. Set where you work from to check your eligibility.

No BS summary

Manager-level contracting systems specialist for a nonprofit health plan. Requires 5+ years in managed care/provider contracting and experience with claims/configuration/testing; QNXT experience preferred. Mostly-remote role supporting Medicare Advantage operations in US states.

Core skills

QNXTContract-to-system configuration alignment

Required skills

Provider contractingContract interpretationClaims adjudicationReimbursement methodologiesUATParallel testingPayment validationMicrosoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft TeamsMicrosoft Outlook

Optional skills

QNXT or other healthcare claims administration platformsContract Lifecycle Management systemsKnowledge of fee schedulesValue-based reimbursement modelsDelegated risk arrangementsMedicare Advantage operationsProject managementProcess improvement

What you'll do

  • Serve as the Contracting subject matter expert for QNXT, contract management system, and other enterprise system implementations.
  • Provide oversight and validation of contract-to-configuration alignment to ensure provider agreements are accurately operationalized.
  • Review complex reimbursement methodologies and contract provisions to identify risks associated with system configuration and claims adjudication.
  • Lead contract-related testing activities including UAT, parallel testing, payment validation, and go-live readiness assessments.
  • Identify, investigate, and escalate discrepancies between contract intent and system outcomes.
  • Partner with Configuration, Claims, IT, Provider Operations, and implementation teams to develop solutions for contract implementation issues.
  • Establish and maintain processes and controls that support ongoing contract-to-system accuracy.
  • Serve as the primary business resource for contract implementation, renewals, amendments, and system enhancement initiatives.
  • Analyze operational and financial impacts of contract implementation decisions and provide recommendations to leadership.
  • Lead special projects and process improvement initiatives supporting enterprise contracting and payment accuracy objectives.
  • Actively support the achievement of SCAN’s Vision and Goals.
  • Other duties as assigned.

What they require

  • Bachelor's degree or equivalent experience in Healthcare Administration, Business Administration, Finance, Information Systems, Public Health, or related field.
  • 5+ years of experience in managed care, provider contracting, network management, claims operations, configuration support, healthcare systems implementation, or related healthcare or health insurance plan operations.
  • Experience interpreting and applying complex provider contract terms, reimbursement methodologies, and payment arrangements.
  • Experience participating in large-scale operational or technology implementations.
  • Experience collaborating across multiple business functions, including Contracting, Claims, Configuration, Operations, Network Management, Finance, and Information Technology.
  • Experience supporting testing, validation, issue resolution, implementation readiness, and production support activities for business-critical systems.
  • Strong analytical experience identifying operational, financial, payment, and implementation risks and developing recommendations for resolution.
  • Microsoft Office (Word, Excel, PowerPoint, Teams, Outlook) at advanced skill level.

Benefits

  • Base salary range: $92,400 to $133,671 per year
  • Internal title: Contracts Manager
  • Work Mode: Mostly Remote
  • An annual employee bonus program
  • Robust Wellness Program
  • Generous paid-time-off (PTO)
  • Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
  • Excellent 401(k) Retirement Saving Plan with employer match and contribution
  • Robust employee recognition program
  • Tuition reimbursement
  • Opportunity to become part of a team that makes a difference

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models.

🇺🇸 United StatesHealthcareEnterprisesjp.sagepub.com/
$92.4k–$133.7k/yr