Provider Contract Consultant

About the role

POSITION DESCRIPTION: With some supervision, leads the Provider contracting, negotiation and execution process. Acts as key strategic contact for Providers, external contracting entities and internal departments, mitigating implementation delays and resolving Provider contracting issues. Performs data analytics to support the contract negotiation process. Performs data input into and extracts information from contracting warehouse. Directly oversees providers contracting inquiries. Under supervision, develops and negotiates contract terms, conditions, modifications, and incentives, while working with key stakeholders to ensure organizational requirements are met. Interacts directly with Providers, with guidance from Provider Contract Manager and/or Director. Participates in Provider recruitment activities as needed.

Responsibilities

• Educates TH Michigan Medical Group Providers and key stakeholders on provider contracting and compensation models, including the on-boarding education program.
• Develops Provider contracts and facilitates contractual negotiations, which include negotiations of compensation, relocation and other contractual terms for relationships between the community health care system and Providers.
• Partners with legal counsel to ensure accurate preparation of contractual documents.
• Provides support to external / sold services contract negotiations.
• Reviews sold services contracts to identify and understand parameters and collaborates with Director of Provider Contracts to facilitate contract development.
• Develops and negotiates Provider recruitment offers within an assigned geographic area.
• Oversees provider contractual agreements, payment to Providers and all records that serve as support for compliance with applicable regulations.
• Oversees Fair Market Value justification process for Provider contracts; works closely with local General Counsel and external FMV consultants.
• Collaborates with Medical Directors and Operations Directors to determine contract strategy and parameters.
• Enters/maintains current information in the internal contract repository system/database.
• Oversees contract implementation and execution process, ensuring that contracts are within required guidelines and financial parameters.
• Identifies barriers and opportunities in the contracting process; articulates issues to leadership for support/guidance as needed.
• Works with and involves relevant stakeholders (internal and external customers) as needed.
• Facilitates contract implementation processes including fielding contract inquiries from Providers and attorneys.
• Creates a customer-focused, service-based consultative approach to working with stakeholders and Providers, which emphasizes the creation and cultivation of cross-organizational relationships.
• Interfaces with Provider Practice Managers, HR leadership, and Medical Staff Office to support on/off boarding process.
• Supports conflict resolution for Providers.
• Maintains professional growth and development through ongoing continuing education and participation in professional organizations.

Qualifications

• Education: Bachelor’s degree required; Master’s degree in Business Administration, Healthcare Administration or other related field preferred.
• Credentials/Licenses: Documentation of education or training in provider contracts. CHC or CMSR certification preferred.
• Experience: Three years of professional contracting. Experience in a complex health care environment. Five years of professional experience, including knowledge of health care compliance, provider contract and compensation management experience preferred. Knowledge of FVM standards, Stark Law, Anti-Kickback Statute, Commercial Reasonableness and Reasonable Compensation rules and Fair Market Value regulations for providers, preferred.

Skills

• Consultative contract negotiating skills.
• Ability to think critically and act independently to approach and solve Provider problems/issues.
• Ability to work collaboratively with internal and external teams to find mutually beneficial outcomes and solutions, and willingness to actively participate and bring forward ideas that lead to process improvement opportunities.
• Ability to influence results, garner support and tactfully manage and maintain complex relationships with leaders, stakeholders and decision makers.
• Ability to analyze and interpret data for appropriate and effective response.
• Analytical thinker, identifies issues and problems; secures and organizes relevant information.
• Understands and properly utilizes IHA’s organizational structure, operations decision-making channels and planning processes to identify potential organization problems and opportunities.
• Ability to perform mathematical calculations, often with a moderate to high level of complexity, during the course of performing basic job duties.
• Proficient in operating a standard desktop and Windows-based computer system including, but not limited to, payroll and accounting systems, email, e-learning, intranet, Microsoft Word and Excel, and computer navigation.
• Ability to use other software as required while performing the essential functions of the job.
• Excellent communication skills in both written and verbal forms, including proper phone etiquette.
• Ability to speak before groups of people, either in-person or virtually, and conduct regular meetings to communicate changes, updates and department goals.
• Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.

Measure by

• Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

Organizational Expectations

• Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of Trinity Health Medical Group.
• Must be able to work effectively as a member of the Finance and IHA leadership teams.
• Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
• Successfully completes all relevant organizational training and adheres to Trinity Health Medical Group standard of care as outlined in the Trinity Health Code of Conduct.
• Maintains knowledge of and complies with Trinity Health Medical Group standards, policies and procedures.
• Maintains general knowledge of Trinity Health Medical Group office services and in the use of all relevant office equipment, computer and manual systems.
• Maintains strict confidentiality in compliance with Trinity Health Medical Group and HIPAA guidelines.
• Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities.
• Embraces new ideas and respects cultural differences.
• Uses resources efficiently.