Provider Partnership Strategist

PacificSource•Portland, OR

About The Position

The Provider Partnership Strategist provides strategic oversight for designated complex provider partnerships, supporting operational efficiency, cost management, quality, and improved health outcomes. The role collaborates with PacificSource stakeholders and external provider representatives to plan, implement, and evaluate Joint Operating Committee (JOC) initiatives, and serves as a primary contact for JOC facilitation. It builds provider relationships through education, reporting, proactive identification of improvement opportunities, and region-specific strategy and coaching. The position manages partnership initiatives and projects across lines of business, supports provider process improvements, coordinates cross-departmental workflows, and tracks project schedules, activities, timelines, and milestones. It provides direct provider support on contracting audits, claims and operational processes, provider education, reporting, and issue resolution. The role works with provider and internal leaders to develop strategic direction and collaborative roadmaps, prepare presentations, conduct operational meetings, and advance quality, incentive, and operational goals. The role requires a thorough understanding of health insurance services, processes, administrative procedures, and government compliance, along with the ability to manage complex projects, develop and execute strategy, understand provider contracts, and analyze data. A BA or BS in business, health care administration, or finance, or equivalent work experience, is desired. Project management experience is preferred. The position works in a general office setting with ergonomically configured equipment and requires travel approximately 25–50% of the time.

Requirements

At least 5 years of experience in the health insurance industry, a provider organization, or an associated field related to partnership building.
Thorough understanding of services and processes, administrative procedures, government compliance, and the health insurance industry.
Demonstrated experience in several of the following areas: managing complex projects, developing and executing strategy, understanding provider contracts and their impacts, process improvement, and data analysis and reporting.
Knowledge of coding methodologies.
General understanding of financial arrangements and quality programs across health care products.
Excellent verbal and written communication skills and the ability to communicate effectively with varied audiences.
Strong public relations and public speaking skills, including the ability to explain plans and administration to groups with varied educational backgrounds and benefits familiarity.
Ability to provide prompt, professional, and courteous service to customers, producers, and PacificSource employees.
Ability to manage shifting priorities and multiple tasks in a fast-paced environment.
Strong work leadership skills, including taking action without specific direction.
High integrity and trustworthiness when handling confidential materials.
Ability to remain resilient, flexible, and focused in a changing environment and work autonomously and independently.
Ability and desire to learn, anticipate problems, and develop contingency plans.
Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.
Ability to stoop and bend; sit and/or stand for extended periods; perform repetitive typing, sorting, and filing; and lift and carry files and business materials.

Nice To Haves

A BA or BS in business, health care administration, or finance, or equivalent work experience.
Project management experience.
Demonstrated ability to facilitate, implement, and measure improvement projects.
Thorough understanding of health care products, contracts, administrative procedures, and the health insurance industry's legal and mandatory guidelines.

Responsibilities

Manage initiatives, activities, and projects arising from partner- or PacificSource-identified opportunities across all lines of business.
Provide ongoing training, coaching, and high-touch support to network system providers and staff to develop and implement process improvement activities.
Collaborate across departments to develop and deploy aligned initiatives, improve workflows, streamline processes, and support provider satisfaction and member care outcomes.
Track project progress and communicate with JOC participants and other stakeholders; develop and manage JOC schedules, timelines, activities, and milestones.
Provide direct provider support through contracting audits and liaison work with internal departments on claims processing, facilities, and group and provider setup.
Educate providers on PacificSource products, administrative procedures, legislative requirements, and compliance requirements.
Work with Provider Network and other departmental leaders and JOC work stream leaders to advance initiatives.
Present and review data with internal stakeholders and business owners, and deliver provider reporting packages.
Identify opportunities and trends, tools, and proposed actions to support incentive, quality, and operational goals.
Work with consultants and hospital departments to develop strategic direction based on current processes and improvement opportunities.
Create and help execute collaborative roadmaps to accomplish established goals.
Prepare meeting materials and presentations with support from Provider Relations Representatives, Quality Coordinators, and other applicable personnel.
Conduct or participate in group operational meetings.
Receive, analyze, and respond to provider issues and ensure timely, appropriate follow-up; identify trends and seek resolutions.
Serve as a provider contact and problem solver for claims, operational, encounter, quality, risk, clinic, billing, health services notification, capitation and financial, contractual, and data or reporting issues.
Understand contracting methodologies and terms across all lines of business.
Build positive working relationships with PacificSource departments and staff to resolve provider issues.
Develop thorough knowledge of Facets setup, Facets Business Support, and other supporting systems.
Exercise independent judgment and communicate effectively between internal and external team members.
Meet department and company performance and attendance expectations.
Follow PacificSource privacy policies and HIPAA requirements concerning protected health information.
Maintain understanding of system setup and reporting requirements and limitations under contractual obligations.
Participate in provider-specific and public presentations as required.
Assist in leading, shaping, and developing special projects related to PacificSource initiatives.
Perform other duties as assigned.