PacificSource Health Plans

IPN Contracting Manager

US-ID-Boise
Job ID
2017-412
Type
Regular Full-Time
Hiring Pay Range
DOE
# of Openings
1
Status
Exempt

Overview

Manage Provider Contracting/Provider Relations and Payor Contracting/Payor Relations for IPN.  Ensure that contracts with Providers and Payors are supportive of IPN operations, protect the integrity of IPN, and can be administered effectively.  Direct development of the provider network, including provider recruitment and establishment of relationships with contract personnel at hospitals, physician groups, and other key providers.  Ensure IPN participation in provider forums or other avenues available to promote participation with IPN and support IPN’s vision as a significant resource to providers.  Maintain excellent client relationships with payors and employers and work to develop new relationships with potential clients.

 

Develop and recommend provider reimbursement and changes in fee schedules. Work with the Executive Director on new initiatives, programs, and strategic planning.

 

Supervise and provide guidance to assigned staff. Maintain communication and coordination with other IPN departments to ensure business continuity and effectiveness, providing a cohesive quality service for IPN customers.

 

Responsibilities

  1. Coordinate business activities by maintaining collaborative partnerships with key departments.
  2. Actively participate as a key team member in manager/supervisor meetings.
  3. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
  4. Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
  5. Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.
  6. Oversee staff responsible for communication with payors and providers regarding contract obligations, claims handling, payor/provider updates, and other IPN requirements. Responsible for approval of material for orientations, presentations, educational resources, contracting packets, and standardized letters and forms for department. 
  7. Oversee the establishment and maintenance of effective contractual relationships between providers and IPN to meet network goals. Review and negotiate contract terms and rates.  Work with staff to see completed contracts through the implementation process, working closely with the necessary parties. Manage the development of provider agreements and amendments or modifications to agreements.
  8. Oversee the establishment and maintenance of effective contractual relationships between payors and IPN to meet membership and revenue goals. Review and negotiate contract terms and rates within given timeframes.  Work with staff to see completed contracts through the implementation process working closely with the necessary parties within the organization.  Manage the development of payor agreements and amendments or modifications to agreements.
  9. Ensure that provider and payor inquiries concerns, contract issues, claims, and reimbursement, etc. are acknowledged and addressed in a timely fashion (typically one business day).
  10. Manage large, special projects such as contract renewals or network development into new areas. Ensure projects are well coordinated and team responsibilities are effectively communicated.
  11. Assist with development of reimbursement models for hospitals, physicians, and ancillary providers based upon financial and actuarial projections. Ensure contract reimbursement is implemented and interpreted correctly internally and externally. 
  12. Oversee maintenance of contract files including amendments, addendums, and attachments. Oversee communication with team members responsible for data entry and management to ensure data accurately reflects contracts with providers and payors.
  13. Coordinate the development and maintenance of the provider and payor manuals and other educational materials as needed.
  14. Direct the development of policies and procedures for contracting and payor/provider relations activities.
  15. Coordinate business activities by maintaining collaborative partnerships with key departments.
  16. Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement.  Where appropriate, utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
  17. Actively participate as a key team member in Manager/Supervisor meetings.
  18. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.

 

Supporting Responsibilities:

  1. Meet department and company performance and attendance expectations.
  2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  3. Perform other duties as assigned.

Qualifications

 

 

Work Experience: Minimum of five years of experience within healthcare either working for a provider (physician’s clinic/office, facility, etc.), third party administrator (TPA) or health insurance carrier.  Equivalent combination of education and experience may apply.  Two to four years of management experience preferred.

                                                                      

Education, Certificates, Licenses: High school graduate required with Bachelor’s degree preferred.  Prefer Certified Professional Coder certification (CPC®.)

 

Knowledge: Effective written and verbal communication skills. Exceptional grammar, spelling, punctuation, consistency, proofreading, and editing skills. Excellent interpersonal skills including negotiating and oral presentation skills.  Basic math skills required, including percentages, ratios, graphing and spreadsheet skills. Strong analytical and problem solving skills, ability to critically review and interpret complex materials. Ability to work under time pressures and varying workloads.  Requires ability to define and prioritize problems and manage workload without direct supervision.

 

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.

 

 

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