Provider Contracting Executive or Senior, DOEHybrid role at our Renton, Tacoma, Spokane, Vancouver and Burlington, WA offices. Candidates must reside within commutable distance of that location or be willing to relocate.
Qualifications: - The Provider Contracting Executive would have a Bachelor's Degree in healthcare, business or a related field and 5 years' experience in a healthcare industry provider contracting, relations, or analytical capacity or equivalent combination of education and experience.
- The Provider Contracting Executive Senior would have a Bachelor's Degree in healthcare, business or a related field and 7 years' experience in a healthcare industry provider contracting, relations or analytical capacity or equivalent combination of education and experience.
Skills and Attributes: - Strong industry knowledge: Strong understanding of managed care and accountable health system models, and their relationship to contracting strategy and reimbursement methodology.
- Negotiation and relationship-building skills: Proven ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
- Payment methodology expertise: Demonstrated competency in varying payment methodologies, including Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, and Per Case.
- Strong understanding of value-based programs and contracting models.
- Proficiency and comfort in negotiating complex contract language.
- Data analysis and strategy development: Ability to analyze financial, quality, and utilization data to develop contracting strategies and manage a portfolio of contracts.
- High-pressure environment skills: Ability to work effectively in high-pressure circumstances, managing conflict and ambiguity.
- Senior-level negotiation and communication skills: Proficiency in building relationships and negotiating successfully with large, complex, and market-leading institutional and professional providers, and ability to independently and effectively communicate with high-level executives internally and externally.
- Leadership and portfolio management: Ability to oversee and manage a portfolio of contracts and provide leadership and guidance to others in the organization.
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia: - Maintains and expands the health care delivery system network by negotiating contracts and maintaining relationships with providers, positioning the organization to meet its objectives relating to cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning, and profitability.
- Monitors financial and utilization performance of contracts, develops plans to improve performance, and meets with key provider leaders to review reports, prepare analysis, and recommend strategies.
- Develops and maintains new regional networks to support the introduction of new products, understanding health plan market pricing and communicating strategic benefits to providers.
- Collaborates with provider consultants and representatives to ensure contracts are administered appropriately and improvement plans are managed.
- Develops and manages risk arrangements, including pricing and accountable health system funding arrangements, and leads plan initiatives/pilots focused on provider network configuration, reimbursement, and management.
- Develop long and short-range contracting strategies for each delivery system assigned, with a focus on reducing healthcare expenditures while delivering high-quality care to members.
- Serves as a mentor to Provider Contracting Executives and others within the department, providing resources and guidance to support the organization's objectives.
Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.
Oregon, Washington, Utah, and Idaho: The expected hiring range for the
Provider Contracting Executive is $84,200 - $113,900 for a
Provider Contracting Executive Senior is $101,200 - $136,900. The bonus target for the
Provider Contracting Executive position is 10%. The bonus target for the
Provider Contracting Executive Senior position is 15%. The current full salary range for the
Provider Contracting Executive role is $79,000 - $129,000 and the
Provider Contracting Executive Senior is $95,000 - $155,000. #LI-hybrid
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.
