Provider Contract Manager (temporary)
Office: Kaiser Permanente Bldg
Overview: Northwest Permanente, P.C. is a self-governed (physician led), multi-specialty group of over 1500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's pre-eminent health care systems, a benchmark for comprehensive, integrated and high-quality care. We are currently seeking a temporary Provider Contract Manager to help support our Provider Contracting and Relations Department.The overall purpose of the Provider Contract Manager position is to effectively manage an assigned portfolio of NWP, KFH and KFHPNW contracted provider relationships in a manner consistent with (1) NWP’s objectives, (2) KFH and KFHPNW’s objectives, (3) NCQA, JCAHO, and other accreditation requirements, (4) applicable federal and state laws and regulatory requirements, (5) meets the Care Delivery needs of KFHP-NW’s Members, and (6) upholds the business, finance, regulatory and reputational interests of KPNW.
Major Responsibilities / Essential Functions:
1. Monitor contract performance to ensure compliance with contract terms and conditions. Collaborate with Care Delivery (Practice Directors, DA’s, Chiefs) in the ongoing clinical, operational and business management of external provider relationships.
2. Coordinate implementation of new contracts as well as administration of existing contracts; work with Provider Relations and Care Delivery partners to assure smooth transition from contracting to service activities.
3. Negotiate and facilitate resolution of complex care delivery, claims payment, utilization management, credentialing and/or other operational issues with provider.
4. Monitor external healthcare delivery marketplace and internal utilization trends. Assess new opportunities for cost savings, alternative delivery models and financial risk sharing
1. Work with Legal, Regulatory and Compliance to assure that contract templates are compliant.
2. Ensure that contracts can be administered within KPNW systems (e.g., Claims payment).
3. Meet all regulations related to the sphere of contracting.
4. Coordinate with Provider and Quality Resource Management Department to ensure timely credentialing of all providers prior to contract being effective.
5. Coordinate with Director, Provider Contract Analytics and Reimbursement, and other KFH/KFHP-NW and NWP Finance staff to develop analyses and payment strategies that will result in cost effective contracts.
6. Coordinate with Provider Configuration to assure that all contracts are loaded accurately and in a timely manner and to avoid negative impact on claims performance due to retro contracts or inaccurate configuration
• Bachelor’s degree or equivalent experience in business, finance, healthcare administration or related field
Minimum Work Experience:
• Minimum of 2 years progressive responsibility and quantifiable results in network development and delivery system negotiations, with experience contracting for multiple managed care products including HMO, PPO, POS, EPO and multiple funding options including fully insured and self-funded plans.
• Strong influencer; demonstrated contributor to building and upholding a positive team culture.
• Strong financial acumen – must possess extensive knowledge of hospital, physician, skilled nursing, and ancillary provider reimbursement models for commercial and government payers, including pay for performance models.
• Knowledge of network development, provider network clinical and business operations, provider relationship management, reimbursement analysis, contract performance analysis.
• General knowledge of legislative and government activities and marketplace issues affecting the region preferred.
• Comprehensive knowledge of Medicare and Medicaid payment methodologies, level of care pricing, and federal and state health care regulations.
• Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, decision making, influence, negotiations, interpersonal relations, oral and written communication, prioritization, problem solving, quality management, systems thinking, teamwork, time management, leadership, facilitation and project management.
• Must be a “self-starter” with a strong sense of initiative and follow-through. Ability to work independently under high-pressure circumstances with little or no supervision.
• Software skills including Microsoft Word, Excel, PowerPoint, Access, Project, and Visio preferred
How to apply: Email Resume to: email@example.com or visit our career website to apply directly