Location: Wenatchee, WA
Facility: Confluence Health
Department:
Schedule: Full Time
Shift: Day Shift
Hours:

Job Description

Position Summary:

The Accountable Care Department is responsible for producing and managing information that assists healthcare providers in ensuring that the right care gets to the right patient at the right time. Currently, the department is responsible for working with specific Medicare Advantage,

Medicaid, and Commercial populations to aid in this effort.

The Provider Network Contract Specialist develops the provider network (physicians, hospitals, ancillary groups, facilities, etc.) for Confluence Health’s Accountable Care Department. This position works to coordinate, develop, monitor and maintain the credentialing, contracting, and enrollment process for new and existing providers under the supervision of the Education and Enrollment Manager.

Essential Functions:

1. Support the department objectives in assuring the strength and breadth of the provider network through contract negotiations that are compliant, financially viable and aligned with company vision metrics.

2. Responsible for the creation and maintenance of provider contracts and files, and contract storage in online contract repository.

3. Evaluate contracts, ensuring compliance with company contract templates, reimbursement structure standards, and other key process controls.

4. Facilitate credentialing process for contracted providers; understand applicable NCQA guidelines.

5. Ensure accuracy of monthly spreadsheets, fee schedule updates and credentialing information sent to the health plans via standardized data cleanup process.

6. Establish and maintain strong business relationships with Hospital, Physician, or Ancillary providers, and ensure the network composition includes an appropriate distribution of provider specialties.

7. Analyze and resolve provider file issues and track progress on network management.

8. Research and propose settlement/resolution for claim issues related to contracting.

9. Demonstrate knowledge of regulatory compliance issues as they relate to provider contracts.

10. Responsible for coordination, research, arrangements, and documentation of contract committee meetings.

11. Support Provider Network Adequacy review and process.

12. Draft and distribute communication with network providers to keep them informed on policy changes and other information impacting provider operations.

13. Serve as primary contact and facilitator for newly contracted providers for credentialing and contract details.

14. Educate providers and personnel on Accountable Care health plan policies and procedures. Will conduct site visits to providers, resolve issues, educate staff/providers on policies, and collect credentialing information.

15. Collaborate with Provider Relations Specialist to distribute information internally for provider changes/adds/terminations/etc.

16. Maintain up to date contracted provider lists on SharePoint site and internal share drives.

17. Perform data cleanup and ensure accuracy of monthly invoices related to provider network information.

18. Special projects as directed and assigned.

Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.

Qualifications:

Required:

Ideal candidate will have experience in contributing to the development of product pricing and utilizing financial modeling in making rate decisions.

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards.

Strong interpersonal skills and ability to develop a rapport with a wide range of personalities.

Candidate must be highly PC literate with proven proficiency in Microsoft Office suite, including skills with Excel and Outlook. SharePoint experience preferred.

Desired:

Bachelor’s Degree in Business, Health Care, Public Administration, Management or other related field preferred.

Previous experience in a medical setting.

Knowledge of health care, managed care, Medicare and/or Medicaid, or medical billing process.

Background in contracting and familiarity with legal language preferred.

Additional Information

Who We Are: Confluence Health is an integrated healthcare delivery system that includes two hospitals and more than 40 medical specialties, to provide comprehensive medical care in North Central Washington. With over 270 physicians and 150 advanced practice clinicians, Confluence Health is the major medical provider between Seattle and Spokane. Our goal is to deliver high-quality, safe, compassionate, and cost-effective care close to home. Staying on the leading edge of healthcare innovation is important, so we invest in technology--to provide better care for our patients and allow our providers to operate at the highest level. Our Mission: We are dedicated to improving our patients' health by providing safe, high-quality care in a compassionate and cost-effective manner. Our Vision: To become the highest value rural healthcare system in the nation that improves health, quality of life, and is a source of pride to those who work here.

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