Director of Provider Contracting

Colorado Access•Denver, CO

3d•$150,700 - $185,600•Hybrid

About The Position

Colorado Access is a Colorado-based company dedicated to improving the health of the state by serving individuals, families, and children who receive healthcare through Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). The company focuses on enhancing quality, member experience, outcomes, and cost. It is a mission-driven organization with a vision for healthy communities transformed by accessible and affordable care, supported by strong values and a commitment to diversity, equity, and inclusion.

Requirements

Bachelor’s degree in a relevant field is required.
Minimum of 7 years health plan or health system provider contracting experience.
5 years of management experience required.
Extensive knowledge of health plan and/or health system contracting, provider reimbursement and claims payment, medical terminology, and health care delivery systems required.
Strategic business planning, change management, people management and project management skills required.
Demonstrates support for the company’s mission, vision and values.
Must have excellent negotiation skills and techniques and be up to date on negotiation strategies.
Position requires excellent written and public speaking communication skills.
Strong interpersonal, relationship building, and strategic partnership development skills with ability to deal with multiple levels of staff.
Training, project development and management skills required.
Strong attention to detail with excellent organizational and time management skills to multi-task and handle high volume workload.
Proficient in Microsoft Office applications (Word, Excel, PowerPoint).
May be required to manage multiple priorities and projects with tight deadlines.
A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Nice To Haves

Equivalent combination of experience and/or education may substitute with a preference for seven years’ progressive relevant work experience.
Master’s degree preferred.
Good knowledge of local health and community agencies and providers preferred.

Responsibilities

Develop strategic direction and oversee the management and maintenance of department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.).
Build high performing teams with vision, leadership, goals and metrics. Serve as a role model for team members; take action and inspire team members to embrace and implement culture initiatives. Provide awareness to staff how their work impacts other departments, programs and the enterprise. Encourage collaboration and hold team members accountable for achieving outstanding results.
Responsible for all management functions including hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees; corrective action procedures and practices, addressing complaints and resolving problems. Develop and manage the department budget.
Work closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborate to deliver on company-wide deliverables/requirements.
Oversee/lead departmental projects and continuous improvement initiatives; may lead cross functional teams.
Develop and implement department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.
Oversee COA provider contracting function; responsible for leading the daily operations of the department and collaborating with other operational departments and functional business unit stakeholders to lead or support various provider contracting functions.
Responsible for strategy development of a high performing network in consultation with Company executive management, legal counsel, medical management staff, and others.
In collaboration with the IT department, support and lead implementation of contracting software and client relationship management tools.
Set strategic direction for the contracting department that aligns with organizational goals and set continuous improvement goals aligned with NCQA requirements, HCPF requirements, and DOI standards.
Successfully negotiate complex contracts with a variety of provider types, including but not limited to primary care, hospital systems and behavioral health providers.
Develop and implement efficient contracting processes, to create and refine contract amendment approval process, and effectively communicate changes to all relevant departments.
Develop and modify, in collaboration with Company legal counsel, standard provider contract templates for all major provider types, and oversee individual modifications as required for specific contracting negotiations.
Collaborate closely with the Network Management Team to ensure network adequacy and network goals are met.
Participate in Joint Operating Committee (JOCs) meetings with key providers and representatives from all aspects of corporate operations including claims, grievance and appeals, medical management, etc.
Analyze the financial results of current contract payment platforms and assess the need and fiscal impact of altering the payment platforms.

Benefits

PTO
Floating holidays
Nine company paid holidays
Employee Assistance Program
Tuition reimbursement
Leadership training
Promotion opportunities
Performance evaluations
Employee recognition
Language pay stipend
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Annual bonus program (based on eligibility, requirements and performance).