Provider Partnership Strategist

PacificSource•Springfield, OR

11h

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 support initiatives, serving as a primary contact for Joint Operating Committee (JOC) facilitation. It builds provider relationships through education, reporting, identification of improvement opportunities, and support for region-specific strategies and coaching. The position manages partnership initiatives and projects across lines of business; supports provider training and process improvement; coordinates JOC schedules, activities, timelines, and milestones; and works with internal departments and provider organizations to improve workflows and member care. It provides support on contracting audits, claims and provider setup processes, education on products and procedures, reporting packages, operational issues, and strategic roadmaps. The role also prepares meeting materials, participates in operational meetings and presentations, identifies trends and solutions, and contributes to special projects.

Requirements

Minimum of 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 areas such as managing complex projects, developing and executing strategy, understanding provider contracts and their impacts, process improvement, and data analysis and reporting.
Knowledge of coding methodologies.
Excellent verbal and written communication skills and ability to communicate effectively with varied individuals and groups.
Strong public relations and public speaking skills; ability to explain plans and administration to groups with varied educational backgrounds and familiarity with benefits.
Ability to provide prompt, professional, and courteous service to customers, producers, and employees.
Ability to work in a fast-paced environment, manage shifting priorities and multiple tasks, and work autonomously and independently.
Strong work leadership skills, including taking action without specific direction.
High integrity and trustworthiness when handling confidential material.
Ability to remain resilient, flexible, and focused in a changing environment.
Ability and desire to learn, anticipate problems, and develop contingency plans.
Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing, sorting, and filing, and lightly lift and carry files and business materials.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.

Nice To Haves

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

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.
Support providers through contracting audits and liaise with internal departments to improve claims processing, facility, group, and provider setup processes.
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, trends, and tools, and recommend actions to help meet incentive, quality, and operational goals.
Work with consultants and hospital departments to develop strategic direction based on current processes and opportunities.
Create and help execute collaborative roadmaps to accomplish established goals.
Prepare meeting materials and presentations with Provider Relations Representatives, Quality Coordinators, and other 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 resolution.
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/reporting issues.
Understand contracting methodologies and terms across lines of business.
Build positive working relationships with PacificSource departments and staff to resolve provider issues.
Develop 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 policy and HIPAA laws and regulations 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.