Provider Contract Manager

PacificSource Health Plans-posted 8 months ago
Full-time • Mid Level
Remote • Hood River, OR
Insurance Carriers and Related Activities
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Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! 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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

  • 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.
  • 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.
  • BA or BS in business, health care administration, finance, or equivalent combination of education and experience required.
  • 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.
  • Flexible telecommute policy
  • Medical, vision, and dental insurance
  • Incentive program
  • Paid time off and holidays
  • 401(k) plan
  • Volunteer opportunities
  • Tuition reimbursement and training
  • Life insurance
  • Options such as a flexible spending account
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