Definition
The Deputy Director of Provider Contract will be responsible for managing the provider contracting function for KHS, including maintenance of agreements, process improvement, performance management, negotiation and re-negotiation of contracts in coordination with the Chief Administrative Officer, Director of Provider Network Management, KHS attorney and staff; Collaborates interdepartmentally on projects related to contracts on an ad hoc basis; reviewing Provider Network Management policy and guidelines and create reports, conduct audits and analyze those results to ensure contract compliance with these policies. Ensure performance of regularly scheduled and ad hoc contract terms are aligned with compliance standards as outlined by KHS governing agencies, i.e. Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC).
Distinguishing Characteristics
This position provides the vital role of maintain network contracting integrity for KHS. This position will ensure that processes are in place and followed in all negotiations, contracting and payment set-up functions.
Essential Functions
- Developing and maintaining contracting templates which comply with regulatory and legal requirements, effectively implementing strategic initiatives which meet KHS business needs;
- Mitigating risk and liability when negotiating agreements and informing and advising appropriate KHS staff, CEO and KHS attorney of such risks;
- Developing and maintaining a work plan and timeline for completing contract development/negotiations, ensuring that contracts and amendments are implemented in a timely fashion;
- Plan, implement and manage contracting strategies to ensure development of contracted providers to support existing and future product lines;
- In coordination with the Compliance Director, ensuring that contracts are reviewed and approved by the KHS various oversight agencies;
- Ensuring effective contracts management, including identifying and tracking of all agreements, termination dates, versioning, etc.;
- Develop and analyze all provider contract rates to ensure budget objectives are met;
- Oversee technical products/software related to fiscal impact reports and rate development for provider contracts.
- Oversee the negotiations for Letter of Agreements and administer the Agreements;
- Negotiate Provider contracts for the provision of all covered benefits including physicians, behavioral health, ancillaries, and hospital agreements;
- Oversight responsibility for the Contract Administration unit including contract development, processing and maintenance of the Agreement;
- Oversee the appropriate contract set-up for all executed contract agreements working closely with the I.T., Configuration and Claims Departments. Additionally, assist in claims reconciliation issues between the Claims Department and contracted providers;
- Responsible for coordinating payment with Finance Department for special funding sources such as Provider Proposition initiatives, Hospital Directed payments, and any other provider payments not included in the overall contractual payment structure.
- Responsible for validating provider eligibility of special provider funding and oversight of payouts. This includes auditing payments and creating departmental procedures to ensure compliance of such funding distributions.
- Work closely with the KHS Legal to ensure compliance with regulatory agencies, KHS Policies and Procedures and KHS legal requirements;
- Assist in the contracting portion of KHS Grant process including but not limited to RFP development, grant review, grant contract development.
- Any other duties as required ensuring the Health Plan operations are successful.
- Provider oversight of contract system configuration and provider set-up.
- Responsible for Credentialing staff and process.
- Oversight of onboarding new providers.
- Responsible for 274 regulatory data submission.
Other Functions
Collaborates interdepartmentally on projects related to contracts on an ad hoc basis, with duties including but not limited to:
1. Overseeing responses to state and federal agencies related to contracts;
2. Participating in external and internal audits, as needed;
3. Implementing contracts to address government mandates and elective projects;
4. Working with internal stakeholders to ensure contract policy and language uniformity when applicable; and
5. Corresponding with vendors and subcontractors to monitor compliance with new laws and policies.
Experience: 7-10 years of managed care experience, emphasis on contracting with a minimum of 5 years of direct experience in analyzing and negotiating contracts. Knowledge of network development. Prior supervisory and project management experience required. Experienced in performing financial and/or statistical analysis.
Education: Completion of Bachelor’s degree in Business Administration, Public Administration or similar degree from an accredited (4) year institution. OR Associate degree plus 15 years of healthcare experience. Master’s degree preferred.
Other: Required travel up to 40%. Possession of valid California Driver’s License and proof of valid State required auto liability insurance.
Knowledge of: Strong analytical skills with emphasis on time management, financial analysis, project management and problem solving. Microcomputer applications (Microsoft Word and Excel) required, for use in all aspects of an office environment. Thorough knowledge of contracting structures and payment methodologies. Excellent communication, negotiation, presentation, interpersonal and organizational skills required.
Ability to:
- Ability to communicate effectively, both orally and in writing;
- Ability to establish and maintain effective and cooperative working relationships with Alliance staff and others contacted in the course of the work;
- Ability to assume responsibility and exercise judgment in making decisions within the scope of authority of the position;
- Ability to think and work independently and effectively under pressure and accurately complete tasks within established times;
- Ability to prioritize tasks and meet deadlines;
- Ability to maintain confidentiality;
- Valid California Driver License, transportation and automobile liability insurance in limits acceptable to the Alliance.
- Must be able to work independently.
- Must be able to learn and retain multiple guidelines and recognize items that fall outside of those guidelines.
- Must be highly motivated, organized, flexible and have good time management and communication skills.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.
Source: Indeed.com
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