Provider Contracting Representative
Posted on: May 3, 2021
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PacificSource is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard
to status as a protected veteran or a qualified individual with a
disability, or other protected status, such as race, religion,
color, national origin, sex, sexual orientation, gender identity or
Diversity and Inclusion: PacificSource values the diversity of the
people we hire and serve. We are committed to creating a diverse
environment and fostering a workplace in which individual
differences are appreciated, respected and responded to in ways
that fully develop and utilize each person's talents and
Position Overview: Accountable to lead, develop, and maintain
strong, positive relationships with assigned standard and complex
provider accounts, including assurance of provider satisfaction
with PacificSource. Proactively manage assigned provider accounts
to achieve PacificSource's strategies and goals for product and
provider contract development
* Develop and maintain effective provider networks and monitor the
adequacy of those networks under the guidance of the Contract
* Accountable for network contracting results for assigned markets
or provider entities and efficiently manage resources to achieve
department goals and initiatives.
* Lead negotiation and implementation of provider contracts for
assigned markets or provider entities and act as the main point of
contact for assigned accounts with respect to negotiations and
* Proactively communicate with PacificSource management on account
status to facilitate proper internal support of account management
* Develop and implement contracting strategies which meet corporate
financial objectives; working within the budgetary guidelines.
* Complete negotiations within preplanned rate targets, meet
timelines, ensure implementation period is timely and takes
responsibility for accurate implementation of the contract is
* Demonstrate advanced knowledge of varying payment methodologies
including but not limited to DRG, Capitation, Fee-for-Service,
RBRVS, Per Diem, Per Case, and Percent of Charges.
* Exercise independent judgment and communicate effectively with
other members of the Provider Network Department and other related
* Communicate regularly with internal staff, departments, and
district offices the status of contract negotiations and potential
impact on operations throughout the negotiation process and obtain
feedback as appropriate to ensure the final contract supports the
PacificSource operational and strategic goals.
* Partner with other Provider Network staff to ensure PacificSource
strategies are being met with the provider community.
* Build and maintain positive provider relationships that foster a
collaborative approach to quality care, network stability and cost
* Accountable for the relationship management for assigned provider
accounts which includes the multi-disciplinary PacificSource team
to provide operationally excellent service and support to the
* Participate in provider specific and public presentations as
* Participate in special projects related to PacificSource
initiatives and other duties as assigned.
* Demonstrate knowledge and support of PacificSource corporate
* Proactively develop positive working relationships with other
PacificSource departments and staff to resolve provider issues.
* Meet department and company performance and attendance
regulations concerning confidentiality and security of protected
* Perform other duties as assigned.
* A minimum of five years of experience in managing provider
relationships and provider contract negotiations.
* Demonstrated ability to develop and execute strategy.
* Proven negotiation experience.
* Demonstrated ability to develop and execute strategy.
Education, Certificates, Licenses: BA or BS in business, health
care administration, finance, or equivalent combination of
education and experience required. Master's degree preferred.
* Excellent public relations and interpersonal skills.
* Excellent written and verbal communication skills.
* Strong analytical skills.
* Ability to draft contract language to meet legal criteria and
familiarity with provisions in health insurance. Excellent
* Understanding of complex financial arrangements and quality
programs across health care products.
* Knowledge of different forms of reimbursement including
capitation and their ramifications on providers as well as
* Strong data management skills.
* Demonstrated knowledge of regulatory issues and network
* Strong experience and expertise in the provider environment.
* Ability to gain a thorough understanding of PacificSource
* Knowledge of provider profiling software, systems, and provider
* Self-starter and the ability to lead with minimal direction.
* Proven ability to lead and mentor small teams.
* Strong organizational, planning and administrative skills.
* Current driver's license and the ability to travel.
* Building Customer Loyalty
* Building Strategic Work Relationships
* Building Trust
* Continuous Improvement
* Contributing to Team Success
* Planning and Organizing
* Work Standards
Environment: Work inside in a general office setting with
ergonomically configured equipment.
* We are committed to doing the right thing.
* We are one team working toward a common goal.
* We are each responsible for customer service.
* We practice open communication at all levels of the company to
foster individual, team and company growth.
* We actively participate in efforts to improve our many
communities-internally and externally.
* We actively work to advance social justice, equity, diversity and
inclusion in our workplace, the healthcare system and
* We encourage creativity, innovation, and the pursuit of
Physical Requirements: Stoop and bend. Sit and/or stand for
extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light
lifting and carrying of files and business materials. Ability to
read and comprehend both written and spoken English. Communicate
clearly and effectively.
Disclaimer: This job description indicates the general nature and
level of work performed by employees within this position and is
subject to change. It is not designed to contain or be interpreted
as a comprehensive list of all duties, responsibilities, and
qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times.
Keywords: PacificSource, Bend , Provider Contracting Representative, Other , Bend, Oregon
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