Manager of Provider Contracts
Company: Partnership HealthPlan of California
Location: Fairfield
Posted on: July 29, 2022
Job Description:
Assist with developing, contracting, implementing, and
maintaining new and existing provider networks. Monitor contractual
relationships with existing PHC contracted providers. Assist with
State and Federal Regulatory reporting of contracts and provider
network.
- Recruit, negotiate, and manage
provider contracts with clinics, safety net providers, physicians,
physicians groups, hospitals, free-standing facilities, ancillary,
and other provider types for all PHC programs.Point person with
provider network for contract issues as required by Director.Assist
with developing draft contracts, coordinate reimbursement rate
terms with PHC Finance department, work with PHC Compliance
department to ensure contract language meets regulatory
requirements.Enter into memorandums of understanding (MOU) and/or
letters of agreement (LOA) with healthcare providers. Effectively
communicate PHC's mission during contracting efforts.Support
northern region office staff with contracting
activities.Participate in routine meetings with northern region
staff to foster collaboration and excellent working
relationships.Work with internal PHC departments to identify
various types of health care providers and facilities for
contracting opportunities.Obtain signatures on original contracts,
contract renewals, and amendments as needed.Ensure PHC provider
network contracts tracking database is maintained per each line of
business.Collaborate with PMO staff for telehealth contracting
activities and/or other alternative network development per PHC
policy. Assist QI department with Quality Improvement Program
(QIP).Review template contracts with Regulatory Affairs department
to ensure contract compliance for all lines of business.
- Prepare contract and provider network information necessary to
support filings with regulatory agencies such as the California
Department of Health Care Services (DHCS), Department of Managed
Health Care (DMHC), and Centers for Medicare Medicaid Services
(CMS). Ensure compliance with NCQA standards.Assist Director with
document for DHCS waivers and network reporting activities.Assist
with documentation preparation required for internal and external
audits.Attend PHC sponsored provider meetings as required by
Director.Conduct visits to provider offices as required during
contracting process.Participate as staff member on Provider
Relations and Finance contracts meetings.Assist in provider
directory maintenance based on contracts.Assist with resolving
provider complaints and problems related to contractual
issues.Maintain and monitor new contracts notification process and
follow up with internal departments to ensure systems are updated
timely. Communicate activities and/or issues identified during
contracting process with Director of Provider Contracts.Education
and Experience - - - - - - - - Bachelor's degree in Healthcare, or
related field; minimum 5 years of experience working with a managed
care organization or health insurer, in a network/contract
management role, such as contracting, provider services, etc.
Experience with complex physician/facility/ancillary contract
reimbursement methodologies.Requires extensive knowledge of State
and Federal regulatory bodies, DHCS, CMS, DMHC, and NCQA. Knowledge
of Medi-Cal and Medicare benefits. Medi-Cal experience with a
variety of contracting models using capitation, fee-for-service,
per diem, case rates, risk arrangements, and pay for performance.
-Special Skills, Licenses and CertificationsKnowledge of managed
care concepts, contracting, policies, and procedures. Working
knowledge of business software applications. Valid California
driver's license and proof of current automobile insurance
compliant with PHC policy are required to operate a vehicle and
travel for company business. -Performance Based
CompetenciesExcellent oral and written communication skills.
Effectively negotiate and build consensus. Ability to be feasible,
adapt to change, and prioritize assignments. Use good judgment in
making decisions within scope of authority and handle sensitive
issues with tact and diplomacy. Apply HIPAA requirements and
maintain confidentiality. Be sensitive and supportive regarding PHC
members and their medical needs. -Work Environment And Physical
DemandsAbility to use a computer keyboard. More than 20% of work
time is spent in front of a computer monitor. Ability to move about
the department freely to assist with operational functions as
needed. When required, ability to lift, move, or carry objects of
varying size, weighing up to 20 lbs. - -All HealthPlan employees
are expected to:
Provide the highest possible level of
service to clients;Promote teamwork and cooperative effort among
employees;Maintain safe practices; andAbide by the HealthPlan's
policies and procedures, as they may from time to time be updated.
-IMPORTANT DISCLAIMER NOTICE -The job duties, elements,
responsibilities, skills, functions, experience, educational
factors and the requirements and conditions listed in this job
description are representative only and not exhaustive of the tasks
that an employee may be required to perform. The employer reserves
the right to revise this job description at any time and to require
employees to perform other tasks as circumstances or conditions of
its business, competitive considerations, or work environment
change.
Keywords: Partnership HealthPlan of California, Fairfield , Manager of Provider Contracts, Executive , Fairfield, California
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