Provider Contract Representative Job at PacificSource Health Plans
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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: Accountable to lead, develop, and maintain strong, positive relationships with assigned standard provider accounts, including assurance of provider satisfaction with PacificSource. Proactively manage assigned provider accounts to achieve PacificSource’s strategies and goals for product and provider contract development.
Essential Responsibilities:
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Develop and maintain effective provider networks and monitor the adequacy of those networks under the guidance of the Provider Network Manager or Director.
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Accountable for network contracting results for assigned markets or provider entities and efficiently manage resources to achieve department goals and initiatives.
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Lead negotiation and implementation of provider contracts for assigned markets or provider entities and act as the main point of contact for assigned accounts with respect to negotiations and service.
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Proactively communicate with PacificSource management on account status to facilitate proper internal support of account management efforts.
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Develop and implement contracting strategies which meet corporate financial objectives; working within the budgetary guidelines.
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Complete negotiations within preplanned rate targets, meet timelines, ensure implementation period is timely and takes responsibility for accurate implementation of the contract is complete.
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Possess basic knowledge of varying payment methodologies including but not limited to DRG, Capitation, Fee-for-Service, RBRVS, Per Diem, Per Case, and Percent of Charges.
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Exercise independent judgment and communicate effectively with other members of the Provider Network Department and other related internal staff.
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Communicate regularly with internal staff, departments, and district offices the status of contract negotiations and potential impact on operations throughout the negotiation process and obtains feedback as appropriate to ensure the final contract supports the PacificSource operational and strategic goals.
Supporting Responsibilities:
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Partner with other Provider Network staff to ensure PacificSource strategies are being met with the provider community.
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Build and maintain positive provider relationships that foster a collaborative approach to quality care, network stability and cost containment.
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Accountable for the relationship management for assigned provider accounts which includes the multi-disciplinary PacificSource team to provide operationally excellent service and support to the accounts.
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Participate in provider specific and public presentations as indicated.
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Participate in special projects related to PacificSource initiatives and other duties as assigned.
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Demonstrate knowledge and support of PacificSource corporate initiatives.
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Proactively develop positive working relationships with other PacificSource departments and staff to resolve provider issues.
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Meet department and company performance and attendance expectations.
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Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
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Perform other duties as assigned.
Work Experience: Minimum of two years of experience in the healthcare industry. Knowledge of healthcare reimbursement required. Two years of experience in managing provider relationships and provider contract negotiations preferred.
Education, Certificates, Licenses: BA or BS in business, health care administration, finance, or equivalent combination of education and experience is required. Current Driver’s License.
Knowledge: Knowledge of different forms of reimbursement including, but not limited to RBRVS, Medicare based reimbursement methodologies, Medicaid reimbursement, capitation and other risk based agreement arrangements and their ramifications on providers as well as insurers. Strong data management skills are essential, along with spreadsheet development, formula writing and a strong command of mathematics and mathematical formulas. Ability to develop and execute strategy. Additionally, have a strong understanding of medical coding (CPT, DRG, HCPC, ICD-10). Knowledge of regulatory issues, national and local healthcare trends and network development is also essential. Demonstrated experience in the provider environment. A thorough understanding of PacificSource products, knowledge of provider profiling software, claims editing software and claims payment systems, and provider data utilization.
Competencies
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Building Customer Loyalty
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Building Strategic Work Relationships
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Contributing to Team Success
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Planning and Organizing
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Continuous Improvement
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Adaptability
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Building Trust
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Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% 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.
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