Senior Manager, Provider and Facility Contracting

HMSA; Honolulu (HI); On-site; USD 90,000 - 120,000; Full time

Job summary

HMSA is looking for a leader to manage the CFR team in Honolulu, Hawaii. Responsibilities include overseeing provider contracts, ensuring compliance with regulations, and fostering high-performing teams. This position is crucial for aligning HMSA's values with provider partnerships and meeting the strategic needs of the organization.

The ideal candidate will possess strong leadership and negotiation skills, a background in compliance and experience in managing daily operations.

This is a hybrid position offering flexibility in work arrangements.

Qualifications

• Experience in managing provider contracting processes.
• Strong knowledge of compliance regulations in healthcare.
• Proven ability to develop and manage high-performing teams.

Responsibilities

• Lead the CFR team in provider contracting responsibilities.
• Oversee daily operations and ensure compliance.
• Participate in corporate strategy related to provider partnerships.

Skills

Leadership

Team Management

Contract Negotiation

Compliance Knowledge

Education

Bachelor's degree or equivalent experience

Job description

Manage CFR Team

• Leadership. Provide direction and guidance to staff on provider issues continually reinforcing partnership and alignment to company and department values and goals. Hold staff accountable to meet commitments, including regularly monitoring and overseeing work to ensure that it is being done timely, and that the department is producing high quality work. Responsibilities also include (1) reviewing and providing guidance to staff for contract negotiations, (2) providing and/or coordinating training for Provider Services staff responsible for contracting operations, and (3) working with other HMSA departments (Compliance and Ethics, government LOBs, etc.) to ensure legal and regulatory compliance of provider contracting function within HMSA.
• Teaming. Build and sustain a high performing provider contracting team. Attract and retain the best talent to meet current and future business needs; develop people to meet both their career goals and the company's goals.
• Managing execution. Provide direction, delegate and remove obstacles to get work done. Plan and prioritize work to meet commitments aligned with organizational goals. Identify areas of development for direct reports and provide development opportunities; assign tasks as appropriate; review, monitor, and provide feedback for continual improvement.
• Oversee CFR operations.
  • Managing the day to day operations of the department,
  • Overseeing personnel, developing and communicating performance measures, conducting periodic reviews, and determining salary changes or other increases in compensation,
  • Hiring and, when necessary, dismissing employees for non-performance, and,
  • Managing contract management and provider contracting operations (accuracy of eVIPs contract record and data entry, system testing, accurate payment outcomes/terms, contract negotiation schedules/timelines, contract timeline ticklers, contract oversight and compliance) to mitigate risk to HMSA and ensure business continuity.
• Compliance. Ensure provider contracts and policies considered an extension of provider contracts within the unit's scope are administered properly by HMSA, including alignment of contractual terms with claims processing, utilization management and appeals. Coordinate internally with other HMSA departments (such as Professional Reimbursement, Claims Administration, Medical Management, BCIS Configuration, Legal, Compliance, and Marketing and Communications, etc.) as needed. Includes contractual compliance to HMSA business, rules/regulations, laws, program requirement.

Provider Strategy

• Aligned with HMSA mission, vision, values and provider strategy, responsible for participating in the development, support and implementation of HMSA's overall provider strategy, including contracting strategy as to hospitals and negotiated and facility contracting. This includes, but is not limited to the following:
• Close participation in various corporate strategy initiatives touching providers, including ACO and other value based arrangements, payment transformation and strategic vendor or quasi-provider relationships.
• Ensure that staff responsible for negotiated and facility contracting are informed and aligned with corporate strategy and initiatives.
• Identify the need for, and coordinate the development of, new contracts and new contracting strategies as required by the ever changing needs of the provider community and HMSA's strategic and tactical initiatives.

Provider Partnership

• Aligned with HMSA mission, vision, values and provider strategy, responsible for developing and maintaining partnerships with strategic provider partners.
• This includes, but is not limited to the following:
  • Conducting provider contracting negotiations.
  • Developing and maintaining positive working relationships with hospital administrators, financial management staff, physician organization leadership, and quality improvement staff.
  • Representing Provider Services on cross-functional projects and teams.
  • As needed, work directly on corporate initiatives including strategic provider initiatives, provide guidance on contract matters to supervisors or other operational staff, including training to new project stakeholders and other employees in contracting practices and procedures.

Other Responsibilities

Perform all other miscellaneous responsibilities and duties as assigned or directed.

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