Provider Contract Manager

3 weeks ago

Helena, United States PacificSource Full time
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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Accountable to lead, develop, and maintain strong, positive relationships with assigned standard and complex provider accounts, including assurance of provider satisfaction with PacificSource. Proactively manage assigned provider accounts to achieve PacificSource's strategies and goals for product and provider contract development

Essential Responsibilities:
  • Develop and maintain effective provider networks and monitor the adequacy of those networks under the guidance of the Contract Management.
  • Accountable for network contracting results for assigned markets or provider entities and efficiently manage resources to achieve department goals and initiatives.
  • Lead negotiation and implementation of provider contracts for assigned markets or provider entities and act as the main point of contact for assigned accounts with respect to negotiations and service.
  • Proactively communicate with PacificSource management on account status to facilitate proper internal support of account management efforts.
  • Develop and implement contracting strategies which meet corporate financial objectives; working within the budgetary guidelines.
  • Complete negotiations within preplanned rate targets, meet timelines, ensure implementation period is timely and takes responsibility for accurate implementation of the contract is complete.
  • Demonstrate advanced knowledge of varying payment methodologies including but not limited to DRG, Capitation, Fee-for-Service, RBRVS, Per Diem, Per Case, and Percent of Charges.
  • Exercise independent judgment and communicate effectively with other members of the Provider Network Department and other related internal staff.
  • Communicate regularly with internal staff, departments, and district offices the status of contract negotiations and potential impact on operations throughout the negotiation process and obtain feedback as appropriate to ensure the final contract supports the PacificSource operational and strategic goals.
  • Partner with other Provider Network staff to ensure PacificSource strategies are being met with the provider community.
  • Build and maintain positive provider relationships that foster a collaborative approach to quality care, network stability and cost containment.
  • Accountable for the relationship management for assigned provider accounts which includes the multi-disciplinary PacificSource team to provide operationally excellent service and support to the accounts.
  • Participate in provider specific and public presentations as indicated.
  • Participate in special projects related to PacificSource initiatives and other duties as assigned.
  • Demonstrate knowledge and support of PacificSource corporate initiatives.
  • Proactively develop positive working relationships with other PacificSource departments and staff to resolve provider issues.
Supporting Responsibilities:
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.
Work Experience: Minimum of 4 years' experience within the health insurance industry, provider organization, or related field in provider reimbursement. Experience should include the proven ability to negotiate, manage provider relationships, and demonstrate the ability to execute strategy.

Education, Certificates, Licenses: BA or BS in business, health care administration, finance, or equivalent combination of education and experience required.

Knowledge: Excellent public relations and interpersonal skills. Excellent written and verbal communication skills. Strong analytical skills. Ability to draft contract language to meet legal criteria and familiarity with provisions in health insurance. Excellent presentation skills. Understanding of complex financial arrangements and quality programs across health care products. Knowledge of different forms of reimbursement including capitation and their ramifications on providers as well as insurers. Strong data management skills. Demonstrated knowledge of regulatory issues and network development. Strong experience and expertise in the provider environment. Ability to gain a thorough understanding of PacificSource products. Knowledge of provider profiling software, systems, and provider data utilization. Self-starter and the ability to lead with minimal direction. Proven ability to lead and mentor small teams. Strong organizational, planning and administrative skills. Current driver's license and the ability to travel.

Competencies:

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time.

Skills:
Accountability, Communication, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.


Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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