Provider Partnership Strategist

PacificSource Health Plans•Salem, OR

2d•$65,297 - $111,005

About The Position

The Provider Partnership Strategist provides strategic oversight for designated complex provider partnerships, with the goal of improving operational efficiency, cost, quality, and health outcomes. The role collaborates with PacificSource stakeholders and external provider representatives to plan, implement, and support Joint Operating Committee (JOC) initiatives, and serves as a primary contact for JOC facilitation. It builds and strengthens provider relationships through education, reporting, identification of improvement opportunities, region-specific strategies, and coaching. The role manages initiatives and projects across lines of business; provides training and support to provider organizations; coordinates process improvements across departments; and tracks project timelines, milestones, and progress. It supports providers with contracting audits and operational matters, educates providers on PacificSource products and requirements, and works with internal leaders and provider partners to review data, develop strategies, and pursue quality, incentive, and operational goals. The position also responds to provider issues, coordinates follow-up, prepares meeting materials, and participates in operational and public presentations as required. The position works inside in a general office setting with ergonomically configured equipment and requires approximately 25–50% travel. Physical requirements include stooping and bending, extended sitting and/or standing, repetitive motions, and light lifting and carrying of files and business materials.

Requirements

At least 5 years of experience in the health insurance industry, a provider organization, or an associated partnership-building field.
Thorough understanding of services and processes, administrative procedures, government compliance, and the health insurance industry.
Demonstrated experience in several of the following: managing complex projects, developing and executing strategy, understanding provider contracts and their impacts, process improvement, 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, including the ability to communicate with diverse audiences and explain plans and administration to groups with varying educational backgrounds and familiarity with benefits.
Strong public relations and public speaking skills, and ability to communicate effectively with internal departments.
Ability to provide prompt, professional, courteous service to customers, producers, and PacificSource employees.
Ability to work in a fast-paced environment, manage shifting priorities and multiple tasks, and work autonomously and independently.
Work leadership skills, including the ability to take action without specific direction.
High integrity and trustworthiness when handling confidential material.
Ability to remain resilient, flexible, and focused in a changing environment; willingness 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 meet the position's physical requirements, including stooping, bending, extended sitting and/or standing, repetitive motions, and light lifting and carrying.

Nice To Haves

BA or BS in business, health care administration, or finance, or equivalent work experience.
Project management experience.
Demonstrated skills in facilitating, implementing, and measuring improvement projects.
Thorough understanding of products, contracts, administrative procedures, and the health insurance industry's legal and mandatory guidelines.

Responsibilities

Manage initiatives, activities, and projects resulting from opportunities identified by provider partners and PacificSource, across all lines of business.
Provide ongoing training, coaching, and high-touch support to network system providers and staff to develop and implement improvement activities.
Collaborate across departments to develop and deploy aligned initiatives, improve workflows, and streamline processes to support provider satisfaction and member care outcomes.
Track project progress and communicate updates to JOC participants and stakeholders; 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 departmental leadership and JOC work stream leaders to advance initiatives.
Present and review data with internal stakeholders and business owners, deliver provider reporting packages, and help identify trends, opportunities, tools, and courses of action to meet incentive, quality, and operational goals.
Work with consultants and hospital departments to develop strategic direction based on current processes and opportunities, and help execute collaborative roadmaps toward established goals.
Prepare meeting materials and presentations with applicable colleagues and conduct or participate in group operational meetings.
Receive, analyze, and respond to provider issues, ensure timely follow-up, identify potential 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.
Develop positive working relationships with PacificSource departments and staff to resolve provider issues.
Develop knowledge of system capabilities related to Facets setup, Facets Business Support, and other supporting systems.
Exercise independent judgment and communicate effectively with internal and external team members.
Meet department and company performance and attendance expectations; follow privacy policies and HIPAA requirements for protected health information.
Maintain understanding of system setup and reporting requirements and limitations related to contractual obligations.
Participate in provider-specific and public presentations as required.
Assist in leading and developing special projects related to PacificSource initiatives, and perform other duties as assigned.