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Manager I, Network Provider ContractingLocation: Atlanta, GA Additional Locations:
Job Number: 780644 Date posted: 03/22/2019
Ensures successful contractual relationships w/ hospitals & community providers. Acts as a liaison between contracted hospitals & Kaiser Permanente to address issues relating to contract administration. Oversees & directs the day to day operations of the provider relations unit. Responsible for peer review, coaching & development of provider relations representatives. May provide input on performance evaluations & participate in goal development.
- Handle all in-bound and general out-bound communications, including phone triage, customer support and correspondence.
- Promotes good provider relations by addressing operational issues & evaluate contract & credentialing compliance.
- Attends Joint Operating Committee meetings as assigned.
- Responsible for contracting w/ Hospital Based Physicians.
- Responsible for the Letter of Agreement Process.
- Tracks & maintains any CPI increase for contracted hospitals.
- Communicates w/ consultants to provide up-to-date information regarding TSPMG.
- Provides feedback to the appropriate management personnel when issues are identified relative to patient care, billing & authorization.
- Works closely w/ Department of Quality Risk Management, Business Office, Claims & Medical Audit to identify & resolve operational issues relating to contract development, administration, & to facilitate quality of service & reimbursement.
- Responsible for implementation of newly developed contracts by providing onsite training & orientation to the community providers' office staff.
- Provides support to the Contract Manager in regards to capitation arrangements w/ Core Consultants.
- Responsible for the analysis & evaluation of metrics to evaluate key business indicators including timeliness & accuracy of contract configuration. Contributes to metrics & analyses for the purposes of vendor oversight, network adequacy (accessibility & capacity), member satisfaction, vendor integrity, business continuity, product recall, etc. & determining appropriate next steps. Oversees development of vendors' corrective action plans & ensures submitted plans meet quality & business process standards. Accountable for ensuring vendors/suppliers are responsive to quality & service level concerns & influencing stakeholders to ensure that interventions are timely & effective.
- Responsible for development & maintenance of positive ongoing relationships w/ community providers. Serves as the key contact for community providers in resolving escalated complex claims concerns & achieving provider satisfaction. This position is also responsible for the regular monitoring, collection, & reporting of performance metrics, territory profile reporting of field operations activities, & the coordination of Kaiser Permanente Payor/Provider conference activities.
- Responsible for the community provider orientation & training process (large & small audiences): Creates trending reference & training materials as needed for different audiences/training topics; Delivers training & orientation classes using appropriate training techniques Provides accurate, timely expertise in KP products & operations; Creates training topics identified from escalated provider concern trends Maintains personal knowledge of product & benefit developments, & organizational & departmental policies & procedures Utilizes approved & branded KP training materials Coordinates w/ PMG w/ the orientation of external providers to Kaiser Permanente's patient management guidelines including authorization & referral processes.
- This job description is not all encompassing.
- Minimum two (2) years of experience in a field position doing provider relations.
- Minimum two (2) years of experience in a field position.
- Minimum two (2) years of public speaking and presentation skills.
- Minimum two (2) years of provider contracting experience.
- Experience in billing department protocol and procedures.
- Bachelor's degree required, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- High ethical standards.
- Proficient in Excel and Word.
- Thorough knowledge and understanding of provider relations, physician reimbursement and managed care contracts.
- Knowledge of physician office operations (example::CPT-4 codes, ICD-9 codes, capitation etc.).
- Minimum five (5) years of experience in Health Care Administration, Managed Care Contracting or Health Care finance is preferred.
- Bachelor's degree in nursing.
- Knowledge of Medicare, Medicaid, regulatory requirements and practice protocols.
- Knowledge of quality assurance and utilization management concepts.
- Knowledge of KFHP contracting process, benefits coverage, QA goals and objectives, medical referrals processing procedures.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
About Health Care & Hospital Operations Careers
Health Care & Hospital Operations Careers
Envision the future, inspire change, and deliver results. Put your talents to work not just at a powerful business, but at an organization dedicated to empowering the health and well-being of millions. As a valued member of the Kaiser Permanente team, your visionary and strategic contributions are especially vital to our success. Come drive change within the organization and across the future of health care.
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Dec 14, 2018
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