Provider Contracting Executive or Senior

Company: Cambia Health Solutions, Inc
Location: Portland
Posted on: May 28, 2023

Job Description:

Provider Contracting Executive or SeniorPortland, Oregon Primary Job PurposeThe Provider Contracting Executive is responsible for contracting relationships with physicians, physician groups, institutions and ancillary providers including the development of contracting strategies, coordination of analytical support, negotiation, and effective administration. They cultivate and maintain relationships with key providers and promote innovative products and reimbursement methodologies.General Functions and Outcomes

• Maintains and expands the health care delivery system network by negotiating contracts and maintaining relationships with providers.
• Cultivates relationships with providers that position the organization to meet its objectives relating to cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning and profitability.
• Monitors financial and utilization performance of contracts and develops plans to improve performance with the Health Care Services division.
• Regularly meets with key provider leaders to review cost/utilization reports, prepares analysis, recommends strategies, researches problem issues and serves as the primary "client manager."
• Develops and maintains new regional networks to support the introduction of new products, maintaining a high understanding of the health plan market pricing and communicates the strategic benefits to providers of participating in new networks and products.
• Works collaboratively with the provider consultants and representatives to ensure that contracts are appropriately administered and that improvement plans are being managed.
• Supports specific initiatives (based on potential cost savings and the impact on member care and providers) which will reduce our healthcare expenditures while still delivering the best care possible to our members.
• Develops and manages risk arrangements including developing, arranging and maintaining pricing and accountable health system funding arrangements.
• Develops long and short range contracting strategies for each delivery system assigned.Minimum Requirements
  • Strong understanding of managed care and accountable health system models and relationship to contracting strategy and reimbursement methodology.
  • Proven ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
  • Demonstrated competency related to varying payment methodologies and value base contracting. (such as Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, Per Case)
  • Ability to analyze financial, quality, and utilization data and use to develop contracting strategies. Ability to organize and manage a portfolio of contracts.
  • Ability to work in high-pressure circumstances and effectively manage conflict and ambiguity. Senior Provider Contracting (requirements in addition to above)
  • Proficiency building relationships and negotiating successfully with large and complex market-leading institutional and professional providers.
  • Ability to independently and effectively communicate with high level executives internally and externally.Normally to be proficient in the competencies listed aboveThe Provider Contracting Executive would have a Bachelor's Degree in healthcare, business or a related field and 5 years' experience in a healthcare industry provider contracting, relations, or analytical capacity or equivalent combination of education and experience.The Provider Contracting Executive would have a Bachelor's Degree in healthcare, business or a related field and 7 years' experience in a healthcare industry provider contracting, relations or analytical capacity or equivalent combination of education and experience.Required Licenses, Certifications, Registration, Etc.Valid driver's license.

Keywords: Cambia Health Solutions, Inc, Portland , Provider Contracting Executive or Senior, Other , Portland, Oregon