Strategic Provider Contracting Lead - Remote

TriWest Healthcare Alliance Corp.; Anchorage (AK); Remote; USD 96,000 - 107,000; Full time

Benefits offered by this job

Medical, Dental and Vision Coverage

Paid time off

401(k) Retirement Savings Plan (with 1

Short-term and long-term disability

Tuition reimbursement

Paid volunteer time

Job summary

TriWest Healthcare Alliance seeks a results-driven contracting professional to develop and maintain provider relationships within the designated state/territory that TriWest is responsible for direct contracting. You will manage hospital, physician and ancillary service agreements, ensuring adherence to government manuals and monitoring network performance across the assigned region.

Further responsibilities include resolving provider access issues, leading negotiations, and communicating market

Qualifications

• Bachelor's degree in Business, Health Care Administration or equivalent experience
• Experience managing large or complex provider contracts
• 5 years of experience in a Managed Care or equivalent health care environment

Responsibilities

• Provides legendary service and support to maintain strong relationships with internal and external customers.
• Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
• Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to Sr. Manager for inclusion in overall network development plans.
• Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities.
• Provides regular updates to the Director and/or VP regarding provider network development, management, and access for assigned areas.
• Monitors and ensures resolution of routine and escalated provider issues.
• Communicates information regarding market needs, competition, and industry trends to management team.
• Provides training and development to team members.
• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Maintains client confidence and ensures confidential information is protected.
• Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
• Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
• Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
• Provides development and training to Network Providers on changes and updates to TriWest processes and policies.
• Identifies issues for future educational seminars that are identified through provider interactions.
• Collaborates with Provider Education to incorporate these ideas in upcoming provider education materials and updates.
• Assists provider community with any claims issues, including Electronic Media Claim filing problems, reimbursement issues, and billing questions. Answer general questions on credentialing process and technical aspects of the Program.
• Monitors and responds to network shortfalls within region.
• Demonstrate and maintain current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Collaborate closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes.
• Head or participate in projects and committees assigned by Sr. Contracting Manager or Vice President.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Skills

Negotiation experience

Provider relations

Contract management

Education

Bachelor's degree in Business, Health Care Administration or equivalent experience

Job description

TriWest Healthcare Alliance seeks a results-driven contracting professional to develop and maintain provider relationships within the designated state/territory that TriWest is responsible for direct contracting. You will manage hospital, physician and ancillary service agreements, ensuring adherence to government manuals and monitoring network performance across the assigned region.

Further responsibilities include resolving provider access issues, leading negotiations, and communicating market