Contract Provider Network Representative V
Kaiser Permanente · Renton, WA · 3 wk ago
Information TechnologyContract
About the role
The individual in this role will be accountable for managing high impact projects which will typically have a Provider Network origination or destination. The successful candidate will drive projects with a broad range of enterprise stakeholders. This is a highly visible role and frequent updates or presentations to local, regional and national leadership will be required. Must have ability to nimbly navigate heavily matrixed internal organizations and overcome barriers to progress. Additionally, this individual will be the relationship manager for third-party or delegated network vendors in collaboration with the Director of Contracting.
Responsibilities
- Grows provider networks by identifying, developing, and maintaining trusted partnerships to fill service gaps or decrease costs.
- Contributes to provider satisfaction by collaborating, creating, and/or delivering training materials to aid provider education and consulting on issues as they arise.
- Promotes network performance through contract and regulatory compliance including network adequacy, claims, disputes, and/or provider directories.
- Supports contract strategy network development by leading collaborative workgroups to ensure provider strategies improve access to patient care.
- Supports continuous improvement efforts by leveraging data to identify, drive implementation, and/or consult on continuous improvement efforts to aid providers and business goals.
- Ensures contract commitments are met by validating, maintaining, and/or conducting statistical analyses on provider and contract data of the day-to-day operation and management of services to identify trends and consult on provider compliance.
- Supports contract strategy development by developing, proposing, and implementing short-term strategies that improve access to patient care while managing outside service costs.
- Grows the Provider Network by reviewing or identifying recommended/potential partners/alliances for assigned service area to fill service gaps or decrease costs in current service offerings using advanced knowledge of current service gaps.
- Contributes to provider satisfaction by leveraging specialized knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, directories, other operational issues, and/or directories.
Requirements
- Minimum three (3) years of experience in a leadership role with or without direct reports.
- Bachelor's degree from an accredited college or university AND minimum seven (7) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field OR Minimum ten (10) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field.
- Project Management Professional (PMP) or equivalent project/program management certification.
- Two (2) years of project management and/or process improvement experience.
Qualifications
- Health Care Industry
- Business Knowledge
- Attention to Detail
- Communication
- Critical Thinking
- Problem Solving
- Teamwork
- Interpersonal Skills
- Training
- Consulting
- Computer Literacy
- Applied Data Analysis
- Knowledge Management
- Time Management
- Short- and Long-term Learning & Recall
Skills
- Leadership
- Project Management
- Collaboration
- Decision Making
- Facilitation Skills
- Quality Assurance Process
- Compliance Management
- Business Planning
- Business Relationship Management
- Business Process Improvement
- Business Acumen
- Health Care Reimbursement
- Topic-Specific Communication
- Organizational Savvy
- Influencing Others
- Learning Agility
- Drives Results
- Problem Solving
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