Provider Relations Executive

Company: Cambia Health Solutions, Inc
Location: Burlington
Posted on: September 20, 2022

Job Description:

Provider Relations Executive or Senior, DOETacoma, Seattle, Burlington or Seattle, WashingtonTeleflexPrimary Job PurposeManages the full provider experience for assigned providers (excluding contracting and negotiation of fee-for-service reimbursement rates and terms), including education, communication, VBA performance, vendor integration into the provider network, and rapport/engagement to build and maintain strong long-term relationships with assigned providers. Drives healthcare transformation to improve quality, cost and consumer/provider experience by working with key strategic provider partners to enable their success in Cambia's value-based arrangements (VBAs) and innovative initiatives as well as develop relationships and capabilities for future value-based arrangements. Manages cross-functional, cross-departmental relationships in support of effective provider partnerships and maintenance of network stability and adequacy.This role is Teleflex and would nee to have flexibility to work both in office and remote is needed.Responsibilities

• Develops and fosters collaborative, productive and professional external partnerships with key providers and internal stakeholders. Brings value and establishes credibility as a trusted advisor and resource to influence positive change while imparting a positive company image and professional demeanor.
• Documents information key to the provider relationship in the documentation platform. Tracks and reports performance on provider engagement and other metrics. Works with internal stakeholders to ensure providers have access to reports and tools to drive performance.
• Maintains detailed knowledge of all value-based arrangements, including contract terms and performance targets, and educates providers and other internal stakeholders.
• Facilitates executive-level Joint Operating Committees with providers to discuss performance success and roadblocks, roadmaps for improving performance, and new collaboration opportunities.
• Facilitates internal and external work groups to review performance reports, identify opportunities and drive action plans to progress towards improved outcomes for clinical quality, cost containment, improved member experience, and enhanced provider experience.
• Drives provider engagement in strategic health plan programs, including Medicare Advantage (MA) HMO activities, MA Quality Incentive Program with assigned provider groups, and adoption of new tools and technology. Coaches provider and promotes the focused use of available resources and tools to improve member health outcomes through provider engagement and enablement. Monitors progress and communicates performance and expectations needed to result in better member health outcomes and efficiencies for the provider and Cambia to drive change.
• Identifies and leads new initiatives that assist providers in transitioning from Fee for Service payment and using innovative payments that promote improvements in quality, cost and member experience.
• Manages the implementation of cross functional organizational strategies, including utilization management, provider data improvements, contracting - focusing on improving the provider experience and member experience and resolution of issues that may impede successful execution of strategies. Ensures provider outcomes goals are aligned with internal strategies.
• Develops and facilitates education and training programs for providers and acts as external point of reference on policies.
• Maintains extensive knowledge of clinical performance levers across all lines of business, such as care gaps, Medicare STARS, and HCC coding; works closely with clinical partner on clinical improvement opportunities.
• Serves as a subject matter expert on competitive intelligence regarding the provider landscape, network performance, value-based care, and cost containment efforts for assigned territory and/or account(s).
• Supports development of new value-based arrangements and other innovative programs and initiatives to drive healthcare transformation.
• Attends meetings externally, as assigned, with the ability to represent the health plan's position on local and national provider programs.
• May occasionally coordinate to resolve escalated provider claims and/or operations issues that may involve internal and external meetings.Requirements
  • Deep knowledge and understanding of the provider community and principles of healthcare delivery systems.
  • Strong communication (written and verbal) and facilitation skills with ability to deliver challenging messages with diplomacy while maintaining strong and trusting relationships with provider partners. Ability to interpret policies and procedures and explain effectively to stakeholders.
  • Self-directed with creative problem-solving skills including the ability to identify problems, develop and recommend solutions, and implement a chosen course of action to resolve issues and build consensus among groups of diverse stakeholders.
  • Professional presence, leadership, and knowledge of helping complex organizations affect change to improve their operations.
  • Strong critical thinking, consulting, and influencing skills at all levels of the organization, both internally and externally, as well as the ability to present complex information simply and succinctly.
  • Demonstrated ability to effectively manage a variety of formal presentation settings; one-on-one, small and large groups and with peers; is effective both inside and outside the organization.
  • Demonstrated ability to take initiative, prioritize work and meet timelines.
  • Knowledge of provider coding, reimbursement, contract methodologies, products and networks. Understanding of value-based arrangements.
  • An understanding of the inputs to the total cost of care for a population, including unit cost, utilization, and other claims costs.
  • Ability to work in a high-pressure environment and effectively manage conflict and ambiguity.
  • Proficiency in using Microsoft Office tools, including Word, Excel and Powerpoint. Familiar with health care systems and infrastructure such as provider file and claims.
  • Ability to travel extensively within the state.Normally to be proficient in the competencies listed aboveProvider Relations Executive would have a Bachelors degree in Healthcare Administration or related field and a minimum of 5 years of experience in the healthcare industry with specific focus in provider relations, provider contracting, customer service, financial analysis: Provider/payer strategy development or implementation; Provider/payer contracting and reimbursement, preferably managed care; delivery system administration, or equivalent combination of education and experience. Valid driver's license is required.Additional Minimum Requirements for Provider Relations Executive, Sr.Strategic understanding of value-based arrangement portfolio, and ability to recommend approaches for providers to advance along the VBA continuum. Refined strategic, investigative, and critical thinking skills to discover new ways to engage providers and solve for the unknown to drive improvements.Demonstrated ability to collect, analyze, organize and interpret data, initiate research and development. Ability to present complex data to all levels of stakeholders both internal and external.Demonstrated leadership abilities as demonstrated by successfully managing and leading complex projects, teams, training, and process improvement.Strong knowledge of provider billing practices, reimbursement methods and alternative payment contract models.Demonstrated knowledge of industry trends, issues, products and solutions, in particular as they relate to healthcare transformation and the migration to value-based arrangements.Customer mindset with proven ability to build positive relationships, gain trust and respect, and influence others.

Keywords: Cambia Health Solutions, Inc, Bellingham , Provider Relations Executive, Other , Burlington, Washington