Senior Provider Contract Manager

Tacoma, Washington

Posted in Insurance

This job has expired.

Job Info

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: Responsible for helping develop and maintain successful execution, coordination and evolution of value-based and alternative payment methodology contracts (VBP/APM). Work with internal PacificSource staff as well as external partnership representatives, such as physicians, executive management and clinical/office staff, to create a plan of collaboration, implementation and success for VBP/APM initiatives. Plan initiatives will focus on defined short and long term targets pertaining to cost containment, quality improvement, patient satisfaction and company strategic plan initiatives. Encourage innovation and help build collaborative provider relationships to achieve PacificSource's strategic goals.

Essential Responsibilities:

  • Serve as lead on high-tier provider contracts with key partners, which include Joint Operating Committee accountabilities, multiple lines of business, upside and downside risk models, shared savings, quality metrics and program payment reimbursement.
  • Serve as primary contact with provider partners for all lines of business contracting including, but not limited to, risk models, shared savings bonus models, ACO and CCO models, full and partial capitation arrangements, Medicaid-specific methodologies, program payments, DRG, fee-for-service, RBRVS, per diem, per case, CMS methodologies, percent of charges and episodic payments.
  • Assist in supporting project plans which may include provider accountability deliverables, innovative reimbursement models, milestones, and quality measurements and revise as appropriate to meet changing needs and requirements.
  • Assist in development and implementation planning of contractual agreements within PacificSource, including all organizational support such as sales, marketing, clinical, actuarial, analytical, underwriting, and technical assistance.
  • Ensure consistency with progressive strategies of PacificSource that pertain to provider relationships and their ability to affect change and reform in the health care system with feedback from EMG, management staff and others on the cross-functional team.
  • Provide support to management related to PacificSource's evolution of current and potential new opportunities for contracting strategies.
  • Keep informed of the evolution of current strategies in discussions related to reform, payment methodologies, risk arrangements, quality metrics and participate in related ongoing analysis.
  • Proactively develop positive working relationships with other PacificSource departments and staff to resolve provider issues.
  • Develop thorough knowledge of system capabilities related to analytics, quality metrics, Facets setup, Facets Business Support, other supporting systems.
  • Exercise independent judgment and communicate effectively between internal and external team members.

Supporting Responsibilities:
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Maintain clear understanding of system set-up and reporting requirements/limitations as required by 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.

Work Experience: Minimum of 6 years' experience in the health insurance industry, provider organization or related field related to high level contractual negotiations and partnership building.

Demonstrated experience in several of the following areas: managing complex projects or project management certification, financial analysis and modeling comprehension, ability to develop and execute strategy, ability to understand multi-faceted contract negotiations and impacts, process improvement, systems redesign, data analysis and reporting, data integrity, team-based improvement, and team facilitation. Demonstrated leadership ability and skills to lead, facilitate, design, implement, and measure improvement projects strongly desired.

Education, Certificates, Licenses: BA or BS in business, health care administration, finance, or equivalent work experience required. AAPC Coding Certification(s) preferred but not required.

Knowledge: Understanding of the following areas: cost and utilization management, quality initiatives, evidence based medicine and care coordination required. Thorough understanding of financial arrangements and quality programs across health care products and lines of business. Knowledge of CPT, HCPC, and ICD-10 coding methodologies required. Possess data management skills, knowledge of regulatory issues and network development. Requires project management skills including provider relations, time management, coordination with other staff, and resource usage. Demonstrated successful communication skills, including public presentation, training, meeting facilitation, and/or broker/agent/provider presentations. Strong interpersonal skills coupled with the ability to foster positive working relationships. Knowledge of health insurance products and service design, concepts, practices, & procedures. Strong experience in the provider environment. Self-starter and the ability to lead with minimal direction. Proven ability to lead and mentor small teams.

  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Contributing to Team Success
  • Planning and Organizing
  • Continuous Improvement
  • Adaptability
  • Building Trust
  • Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25-50% of the time.

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

This job has expired.

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