Manager of Provider Network and Pricing Strategy

Job Description:

Shift: First Shift,Mon,Tue,Wed,Thu,Fri

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

Position Summary:

The Manager of Provider Network and Pricing Strategy is responsible for overseeing all provider contract network data functions within a Third-Party Administrator (TPA) environment. This includes managing provider fee schedule, and demographic information, loading and maintaining configuration data, ensuring accuracy across systems, and leading the team responsible for provider file management, fee schedule configurations, and network updates. The role serves as the primary liaison between internal operations, IT, provider relations, repricing vendors and external network partners to ensure timely and accurate provider setup and ongoing maintenance.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Provider Data Management

• Oversee the accurate collection, validation, and maintenance of provider information, including addresses, specialties, taxonomies, TINs, NPIs, contracts, fee schedules and credentialing status.
• Ensure timely processing of provider additions, terminations, updates, and demographic corrections in accordance with regulatory or partner requirements.
• Implement and maintain processes for validating provider data received from internal networks, health plans, or provider groups.
• Monitor and manage data discrepancies, duplicates, or mismatches within the provider database.

Configuration & System Loading

• Manage the loading of network configurations, fee schedules, provider pricing, contract rules, and reimbursement logic into repricing and TPA systems.
• Oversee configuration of benefit, network, and pricing tables to support accurate claims adjudication.
• Perform quality assurance and audits to validate configuration and fee schedule accuracy and system integrity.
• Coordinate with IT to troubleshoot provider file issues, system errors, or configuration defects.
• Lead user acceptance testing (UAT) for new system functionality, upgrades, or network changes.

Network Partner Coordination

• Serve as the primary point of contact for external network partners, provider groups, and repricing vendors regarding rosters, demographic maintenance, and contract management.
• Review and interpret provider contracts and network participation documents to ensure proper system setup.
• Support network audits, provider data reconciliation, and process improvements with external partners.

Cross-Functional Collaboration

• Collaborate with Claims, Provider Relations, Client Services, Compliance, vendor partners and IT to ensure provider data supports operational accuracy and service goals.
• Provide subject matter expertise for provider contract setup, pricing logic, and network hierarchy.
• Participate in client implementations and renewals to configure provider networks, repricing and fee schedule management.

Team Leadership

• Supervise and develop a team of provider data analysts, configuration specialists, or Network Maintenance staff.
• Establish performance metrics, monitor workloads, and ensure adherence to quality and timeliness standards.
• Create and maintain department documentation, workflows, SOPs, and training materials.

Compliance & Quality Assurance

• Ensure provider contract data processes comply with federal and state regulations, including credentialing standards, and network adequacy requirements.
• Maintain audit trails for all provider updates and configuration changes.
• Lead process improvement initiatives to increase automation, accuracy, and operational efficiency.
• Other possible duties as may be assigned.

Experience and Skills:

GENERAL EXPECTATIONS:

• Present a positive image of Consociate Health at all time.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a cus…