- Oversees development and implementation of HMSA's provider contracting strategy and the primary team responsible for execution of provider contracts.
- 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 deliverable dates are established and met, 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 across all HMSA departments to ensure legal and regulatory compliance of provider contracting function within HMSA.
- Teaming
- Build and sustain a high performing provider contracting team.
- Attract, coach, and retain the best talent to meet current and future business needs; develop people to meet both their career goals and HMSA's goals to establish a viable and quality centric provider network.
- Managing execution
- Directly facilitate complex negotiations, Provide direction to staff in negotiations, delegate and remove obstacles to get work done.
- Plan and prioritize work to meet commitments aligned with organizational goals.
- Ensure that staff responsible for contracting are informed and aligned with corporate strategy and initiatives.
- Oversight and management of CFR operations
- 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.
- Development and implementation of departmental operational improvement projects and reporting which increase efficiency, reduce administrative burden, and improve coordination and cooperation of inter-departmental hand offs.
- Training of contracting staff on current reimbursement models and contracting terms to aid in negotiations. Training contracting staff to conduct strategic, analysis-based conversations with providers regarding contracts and reimbursement.
- Development of tools and workflows so contracting staff may analyze and assess provider negotiation requests related to market trends, reimbursement, claims revenue and network adequacy.
- Ensure provider contracts and Provider Resource Center 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 various HMSA departments as needed. Includes contractual compliance to HMSA business, rules/regulations, laws, program requirement.
- Provider Strategy and Partnership. Aligned with HMSA mission, vision, values, and provider strategy, responsible for participating in the development, support, and implementation of HMSA's overall provider strategy across all providers.
- Active participation in various corporate strategy initiatives involving provider network, including ACO and other value-based arrangements
- Development of contracting strategies to achieve HMSA's strategic and tactical initiatives. Includes development of new contracts and contract templates.
- Conduct strategic, analysis-based conversations with providers regarding contracts and reimbursement.
- Develop and maintain positive working relationships across the provider network to include hospital administrators, financial management staff, physician organization leadership, and quality improvement staff.
- Perform all other miscellaneous responsibilities and duties as assigned or directed.
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HMSA
Jan 08, 2025