Provider Network Contract Administrator
Job description
This position is available fully remote in Washington State only.
Job Summary
The Contract Administrator is accountable for developing, maintaining, and expanding the provider network and, conducting negotiations with various provider types.
Essentials Functions
Contract Negotiations
- Negotiates hospital, physician groups, ancillary providers, and behavioral health agency contracts, and other provider types as needed.
- Performs contracting negotiation using reimbursement strategies that are aligned with Community Health Plan of Washington objectives and meet the needs of the provider communities.
- Ensures provider negotiations and contracts are managed in a way that is in compliance with various regulatory agencies, i.e., OIC, HCA, and CMS.
- Assures maintenance of accurate, current, detailed files with important providers.
- Proactively identifies and addresses gaps in the provider network to improve member access and meet Community Health Plan of Washington’s network adequacy and regulatory requirements.
- Prepares and distributes necessary documents to complete the contracting process to operationalize contracts.
Maintain and Improve Contracted Provider Relationships
- Initiates and maintains productive long-term relationships with the provider networks and other agencies such as mental health and substance use disorder agencies.
- Communicates proactively with other departments to ensure effective and efficient business results.
- Develops and uses effective cost and utilization reports for the administration of the contracted relationship.
- Leads teams of Community Health Plan of Washington subject matter experts to resolve provider specific and systemic operational issues.
- Participates and reviews Community Health Plan of Washington’s policies and procedures that impact provider relations and contracting.
- Responds effectively to HCA, CMS and OIC complaints submitted by providers.
- This position involves traveling on behalf of the Company. It is essential that a current driver’s license, an acceptable driving record, and proof of automobile are maintained.
Other Functions:
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
Qualifications
Education
- Bachelor’s degree (in Business Administration, Finance, or related field) or an equivalent combination of education and highly relevant experience required.
Experience
- Minimum 2 years of contracting and/or contract management in Managed Care required.
- Minimum 4 years contracting and servicing providers in an insurance setting, hospital, Behavioral Health environment, or other clinical settings preferred.
Employment Eligibility
- Complete and successfully pass a criminal background check
- Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
Knowledge, Skills, and Abilities
- Knowledge of provider reimbursement models
- Requires knowledge and experience in contract negotiations with various reimbursement methodologies such as fee for service and value-based arrangements.
- Must be able to maintain current contracting strategies in a managed care setting.
- Maintains knowledge of state and federal regulatory requirements as it relates to provider contracting.
- Ability to meet scheduled deadlines with minimal supervision.
- Strong organizational skills and accurate work results.
- Proven track record of maintaining a professional appearance, demeanor and confidentiality.
- Excellent public speaking, written communication and problem solving skills.
- Ability to understand and communicate various services and products of Community Health Plan of Washington.
- Strong analytical and negotiation skills.
- Ability to work in a team environment.
CHPW OFFERS ROBUST TOTAL REWARDS
The position is FLSA Exempt (salary) and is not eligible for overtime. The position is also eligible for as an annual incentive based on company, department, and individual performance goals. Full and Part - time employees have the option to enroll in medical, dental, vision and voluntary life insurance benefits, and 401(k) retirement benefits effective the 1st of the month following or coinciding with their start date. CHPW provides a 6% 401(k) employer match, Basic Life, Accidental Death and Dismemberment insurance, short and long-term disability, financial coaching, and wellness programs at no cost.
CHPW employees start earning 17 days of Paid Time Off (PTO) and receive 40 hours of community service for volunteer time, and two floating holidays immediately. The company offers 10 standard holidays, paid jury duty and compassion time.
CHPW offers a monthly stipend to offset work-from-home expenses for roles that are 100% remote.
SENSORY/PHYSICAL/MENTAL REQUIREMENTS
Sensory*:
- Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
Physical*:
- Extended periods of sitting, computer use, talking and possibly standing
- Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
- Frequent torso/back static position; occasional stooping, bending and twisting
- Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching
Mental:
- Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.
WORK ENVIRONMENT
Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.
PROTECTED HEALTH INFORMATION (PHI) ACCESS
All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW. This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.
- Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
This job description is intended to describe the general content and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.
Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
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