Provider Relations and Contracting Manager (Iowa)

About the role

The Manager of Provider Relations and Contracting role at HealthPartners is responsible for managing strategic relationships with providers, including provider contracting, financial analysis, operations management, and development of strategic partnerships.

Responsibilities

• Supervise staff, including hiring, transferring, laying off, promoting, disciplining, and reviewing performance.
• Ensure compliance with organizational and departmental policies and procedures.
• Develop and implement network contracting strategies consistent with HealthPartners' objectives.
• Develop and implement sound reimbursement methodology for providers.
• Negotiate contract terms with providers.
• Work with government programs management to ensure compliance with Medicare product requirements and regulations.
• Create product-specific networks as directed by HealthPartners indicatives.
• Coordinate communications between the Health Plan, primary care, specialty, and institutional providers.
• Manage the day-to-day operational needs related to providers.
• Supervise and mentor direct reports, including service specialists and contract consultants when applicable.
• Perform project management duties for various projects enhancing strategic contracted partnerships and services.
• Investigate, mediate, and resolve inquiries regarding the delivery of care by providers.
• Provide support to the Quality Utilization Management Department in analyzing provider trends and developing action plans to effect change.
• Independently manage and supervise the administrative functions relating to the contracted providers, including network strategy development, financial analysis, negotiations, contract drafting, contract monitoring, establishing provider relations and communications.
• Independently manage and supervise the implementation of provider contracts.
• Develop systems, policies, and procedures to communicate and ensure the successful implementation of contracts by various internal departments.
• Independently manage and supervise contract maintenance and contract filing functions.
• Develop and maintain systems and procedures to ensure the collection of credentialing information.
• Ensure the contents and filing of contracts and amendments are in accordance with Minnesota Department of Health, government programs, accreditation, and other regulatory agency requirements.
• Ensure the maintenance of current provider listings for internal uses and to ensure that contracts are current and up to date with all necessary or required contract provisions.
• Maintain contract compliance and adherence to contract provisions by providers and HealthPartners departments.
• Monitor the payment of claims by HealthPartners to ensure the correct application of contract payment terms.
• Take corrective action with providers who are not complying with contract terms or with HealthPartners departments not adhering to contract agreements.
• Participate in year-end contact settlement process, where appropriate.
• Develop and implement appropriate reimbursement methodologies such as capitation, case rates, fee schedules, per diems, Ambulatory Patient Classifications, and Diagnostic Related Groups.
• Monitor, analyze, and interpret financial and utilization patterns of providers.
• Implement corrective action steps as necessary.
• Manage the operational, financial, and administrative relationships with providers.
• Support the Medical Director, Associate Medical Directors, and Department Heads to coordinate communications and operations.
• Participate in annual planning exercises for the Department, Contracted Care Division, and HealthPartners.
• Participate in and create business continuity and disaster recovery plans and tests.

Qualifications

• Bachelor’s degree in health care administration, business administration, or other relevant field.
• Minimum of seven years experience working in the health care industry, with three years in a provider relations/provider administrative role.
• Previous experience in a management position, independently responsible for planning and development of a key company function.
• Strong analytical and financial modeling skills.
• Ability to develop and evaluate contracting strategies.
• Strong oral and written skills with the ability to make effective group presentations and consensus building.
• Excellent team leadership skills with a sound level of interpersonal effectiveness.
• Ability to work independently, making independent decisions as they relate to the successful relationships with providers, consistent with HealthPartners goals.

Preferred Qualifications

• Strong financial and systems background.
• Previous experience in provider contract negotiations.
• Previous experience in health care industry.
• Additional two years experience in network development in specific products, e.g., workers compensation.