PacificSource Health Plans

  • IPN Provider Contract Specialist

    Job Location US-ID-Boise
    Job ID
    2018-248
    Type
    Regular Full-Time
    Hiring Pay Range
    $50k-$60k
    # of Openings
    1
    Status
    Exempt
  • Overview

    Accountable to lead, develop, and maintain strong, positive relationships with providers, including assurance of provider satisfaction with IPN.  Negotiates agreements and rates which support IPN and PacificSource strategies and goals for product and provider contract development. 

    Responsibilities

    1. Develop and maintain effective provider networks and monitor the adequacy of those networks under the guidance of IPN management.
    2. Recruit and negotiate terms with providers, as required to meet IPN and PacificSource goals and all client access standards.
    3. Accountable for network contracting results for provider contracts and efficient management of resources to achieve department goals and initiatives.
    4. Lead negotiation and implementation of provider contracts and act as the main point of contact for providers with respect to negotiations and service.
    5. Exercise independent judgment and proactively communicate with IPN and PacificSource network management on contracting status to facilitate proper internal support of provider contract management efforts.
    6. Develop and implement contracting strategies which meet corporate financial objectives; working within the budgetary guidelines.
    7. Complete negotiations within preplanned rate targets, meet timelines, ensure implementation period is timely with respect to system setup and payor agreement requirements and take responsibility for accurate implementation of the contract once it is complete.
    8. Possess knowledge of varying payment methodologies including but not limited to DRG, Capitation, Fee-for-Service, RBRVS, Per Diem, Per Case, and Percent of Charges.
    9. Exercise independent judgment and communicate effectively with other members of IPN, PacificSource Provider Network department and other related internal staff.
    10. Communicate regularly with IPN and PacificSource management the status of contract negotiations and potential impact on operations throughout the negotiation process and obtain feedback, as appropriate, to ensure the final contract supports IPN and PacificSource operational and strategic goals.
    11. Assist with development of new fee schedules and reimbursement methodologies and annual review of IPN and PacificSource provider agreements.
    12. Communicate effectively with providers by letter, email, phone or personal visit to maintain provider satisfaction.

     

    Supporting Responsibilities:

    1. Partner with IPN Payor Relations, Provider Relations, Customer Service and PacificSource Provider Network staff to ensure IPN and PacificSource strategies are being met with the provider community.
    2. Build and maintain positive provider relationships that foster a collaborative approach to quality care, network stability and cost containment.
    3. Accountable for the relationship management for provider contracts which includes the IPN and PacificSource Network teams to provide operationally excellent service and support to providers.
    4. Participate in provider specific and public presentations and/or conferences as needed.
    5. Participate in special projects related to IPN and PacificSource initiatives, providing leadership as assigned.
    6. Demonstrate knowledge and support of IPN and PacificSource corporate initiatives.
    7. Proactively develop positive working relationships with PacificSource, IPN payors and other departments and staff to resolve provider issues.
    8. Contribute to IPN provider newsletter monthly, or as requested.
    9. Contribute to development and review of department policies and procedures.
    10. Meet department and company performance and attendance expectations.
    11. Follow the IPN and PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    12. Actively participate in payor, provider and team meetings as necessary.
    13. Provide back up to other IPN and PacificSource team members as needed.
    14. Participate in all required training or department meetings.
    15. Perform other duties as assigned.

    Qualifications

    Work Experience: Minimum of two years of experience in managing provider relationships and contract negotiations in the healthcare setting:  network, physician’s clinic/office, facility, Third Party Administrator or health insurance carrier. Ability to develop and execute strategy.  Experience in public speaking and professional communication, both verbal and written is required. 

     

    Education, Certificates, Licenses: BA or BS in business, health care administration, finance, or equivalent experience. Current Driver’s License required. Certified Professional Coder certification (CPC®) preferred.

     

    Knowledge: Demonstrated knowledge of various physician and facility reimbursement arrangements. Strong data management skills are essential, along with spreadsheet development, formula writing and a strong command of mathematics and mathematical formulas.  Additionally, must 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. Knowledge of regulatory issues, Medicare regulations, national and local healthcare trends and network development is also essential.  Self-starter with proven ability to lead with minimal direction.  Strong organizational, planning and administrative skills.  Proficiency with Excel, PowerPoint and SharePoint preferred.  Must have the ability to travel.

     

    Competencies

    Our Values

    • Adaptability
    • Building Customer Loyalty
    • Building Strategic Work Relationships
    • Building Trust
    • Continuous Improvement
    • Contributing to Team Success
    • Planning and Organizing
    • Work Standards
    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for our customers’ experience.
    • 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 communities-internal and external.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

     

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

     

    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.

     

    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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