Bachelor's degree and six years of related work experience, or equivalent combination of education and experience.
Two years of previous management/supervisory experience.
Experience in a highly regulated industry.
Expertise in negotiating contracts and/or vendor/contract management.
Strong analytical, planning, organizational, and interpersonal skills. Excellent written and verbal communication capabilities.
Responsibilities
Lead and manage the CFR team and contracting function in Provider Services.
Provide direction, guidance, and training for contracting staff to ensure alignment with company goals.
Manage daily operations of the CFR department, including personnel oversight and performance management.
Ensure compliance with legal and regulatory requirements in provider contracts and policies.
Participate in the development and implementation of HMSA's overall provider strategy and contracting initiatives.
Build and maintain partnerships with strategic provider partners and enhance negotiation processes.
Oversee contract management operation to manage risks and ensure continuity.
Benefits
Hybrid work model offering flexibility between in-office and remote work.
Opportunity for professional development and career advancement.
Access to comprehensive health and wellness benefits.
Collaborative and supportive team environment.
Involvement in strategic initiatives impacting the healthcare community.
Full Job Description
Manage CFR Team
You are responsible for leading and managing the contracting function in Provider Services and overseeing the work of the employees in the CFR department as well as outside contracted vendors. These responsibilities include, but are not limited to, the following:
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 it is being done timely, 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 with other HMSA departments (Compliance and Ethics, government LOBs, etc.) to ensure legal and regulatory compliance of provider contracting function within HMSA.
Teaming. Build and sustain a high performing provider contracting team. Attract and retain the best talent to meet current and future business needs; develop people to meet both their career goals and the company's goals.
Managing execution. Provide direction, delegate and remove obstacles to get work done. Plan and prioritize work to meet commitments aligned with organizational goals. Identify areas of development for direct reports and provide development opportunities; assign tasks as appropriate; review, monitor, and provide feedback for continual improvement.
Oversee CFR operations. Oversee and manage operations of CFR department, including
Managing the day to day operations of the department,
Overseeing personnel, developing and communicating performance measures, conducting periodic reviews, and determining salary changes or other increases in compensation
Hiring and when necessary dismissing employees for non-performance, and,
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.
Compliance. Ensure provider contracts and 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 other HMSA departments (such as Professional Reimbursement, Claims Administration, Medical Management, BCIS Configuration, Legal, Compliance, and Marketing and Communications, etc.) as needed. Includes contractual compliance to HMSA business, rules/regulations, laws, program requirement.
Provider Strategy
Aligned with HMSA mission, vision, values and provider strategy, responsible for participating in the development, support and implementation of HMSA's overall provider strategy, including contracting strategy as to hospitals and negotiated and facility contracting. This includes, but is not limited to the following:
Close participation in various corporate strategy initiatives touching providers, including ACO and other value based arrangements, payment transformation and strategic vendor or quasi-provider relationships.
Ensure that staff responsible for negotiated and facility contracting are informed and aligned with corporate strategy and initiatives.
Identify the need for, and coordinate the development of, new contracts and new contracting strategies as required by the ever changing needs of the provider community and HMSA's strategic and tactical initiatives
Provider Partnership
Aligned with HMSA mission, vision, values and provider strategy, responsible for developing and maintaining partnerships with strategic provider partners.
This includes, but is not limited to the following:
Conducting provider contracting negotiations.
Developing and maintaining positive working relationships with hospital administrators, financial management staff, physician organization leadership, and quality improvement staff.
Representing Provider Services on cross-functional projects and teams.
As needed, work directly on corporate initiatives including strategic provider initiatives, provide guidance on contract matters to supervisors or other operational staff, including training to new project stakeholders and other employees in contracting practices and procedures.
Perform all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
Bachelor's degree and six years of related work experience, or an equivalent combination of education and work experience.
Two years of previous management/supervisory experience.
Communicate clearly and concisely, both verbally and in writing. Establish and maintain effective working relationships with those contacted in the course of work.
Excellent interpersonal skills.
Strong analytical skills.
Strong leadership skills.
Strong planning and organization skills.
Excellent supervisory/management skills.
Excellent leadership skills.
Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.
