Provider Partnership Strategist

PacificSource Health Plans•Springfield, 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 evaluate Joint Operating Committee (JOC) initiatives, and serves as a primary contact for JOC facilitation. It builds and strengthens strategic provider relationships through education, reporting and analysis, proactive identification of improvement opportunities, and support for region-specific strategies and coaching. The position manages initiatives and projects across lines of business; coaches and supports provider systems and staff; coordinates cross-department process improvements; tracks milestones and communicates progress; and helps providers resolve contracting, claims, setup, operational, quality, financial, and reporting issues. It also supports provider education, presentations, data reviews, strategic roadmaps, and special projects. The role works autonomously, handles shifting priorities, and protects confidential information in accordance with PacificSource policy and HIPAA requirements. The work is performed in a general office setting with ergonomically configured equipment. Travel is required 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: 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 the ability to communicate effectively with people of varied backgrounds.
Strong public relations and public speaking skills, including the ability to explain plans and administration to groups with varying educational backgrounds and familiarity with benefits.
Ability to provide prompt, professional, courteous service to customers, producers, and PacificSource employees.
Ability to work in a fast-paced environment while managing shifting priorities and multiple tasks.
Strong 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 and to 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 stoop and bend; sit and/or stand for extended periods; perform repetitive typing, sorting, and filing; and lift and carry files and business materials lightly.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.

Nice To Haves

BA or BS in business, health care administration, finance, or equivalent work experience.
Project management experience.
Demonstrated skills in facilitating, implementing, and measuring improvement projects.
General understanding of financial arrangements and quality programs across health care products.
Thorough understanding of 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 improvement activities.
Collaborate across departments to develop aligned initiatives, improve workflows, streamline processes, and enhance provider satisfaction and member care outcomes.
Track project progress, communicate with JOC participants and stakeholders, and manage JOC schedules, timelines, activities, and milestones.
Support providers with contracting audits and liaise 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 work-stream leaders to advance JOC initiatives.
Present and review data, deliver provider reporting packages, and help identify opportunities, trends, tools, and courses of action to meet incentive, quality, and operational goals.
Work with consultants and hospital departments to develop strategic direction and create and execute collaborative roadmaps.
Prepare meeting materials and presentations and conduct or participate in group operational meetings.
Analyze and respond to provider issues, ensure timely 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/reporting issues.
Understand contracting methodologies and terms across lines of business.
Develop positive working relationships with PacificSource departments and staff to resolve provider issues.
Develop knowledge of Facets setup, Facets Business Support, and other supporting systems.
Use independent judgment and communicate effectively with internal and external team members.
Meet department and company performance and attendance expectations and comply with privacy policy and HIPAA requirements.
Maintain understanding of system setup and reporting requirements and limitations related to contractual obligations.
Participate in provider-specific and public presentations and help lead, shape, and develop special projects related to PacificSource initiatives.