Network Contracting Consultant

About Us

The Iowa Primary Care Association (Iowa PCA) has supported Iowa’s community health centers for over 36 years to expand access to affordable, high quality, integrated care. The Iowa PCA, along with our sister companies INConcertCare (INCC) and IowaHealth (IH ), provides training, technical assistance, and shared services opportunities in quality improvement, value-based care, health information technology, and other areas. We are now expanding our services through a new partnership with Iowa Health and Human Services to serve as the new statewide Behavioral Health Administrative Service Organization (BH-ASO). It’s an exciting opportunity to expand our efforts and connection to the broader behavioral health safety net.

Position Overview

The Network Contracting Consultant is responsible for the negotiation, processing, and compliance monitoring of provider contracts for the organization’s ASO operations. Reporting directly to the Director of Network Development, this position ensures that the organization meets all state, federal and contractual requirements while effectively managing provider agreements.

Key Responsibilities

1. Network Development and Contracting

• Implement, execute and maintain provider contracts that support the establishment and then expansion of Iowa’s BHSS in alignment with the organization’s goals, objectives, and service delivery expectations.
• Support negotiation and management of contracts with clinical and service providers ensuring contract terms, including service provision, quality standards, accessibility, payment structures and accountability, are in alignment with company goals and compliance with regulatory requirements.
• Establish and review contracts for consistency and effectiveness in service delivery, billing practices and patient care standards, as well as alignment with the strategic goals of the BHSS.
• Maintain a centralized contract repository and track key contract deadlines, amendments and renewals.

2. Provider Relations

• Assist the Director of Network Contracting and Provider Relations and General Counsel in researching and recommending actions to resolve contract related provider issues and concerns.
• Track contract related provider issues to resolution. Identify trends and propose and develop network solutions.
• Develop and update provider training to empower provider contract compliance.
• Support communication with providers to discuss contract compliance.

3. Performance Management

• Assist Director of Network Contracting and Provider Relations and General Counsel in developing audit and review schedules and criteria.
• Conduct regular audits and reviews to ensure providers are in compliance with contract terms, including regulatory requirements, credentialing and service delivery and quality standards.
• Prepare and/or review reports for leadership, state agencies and regulatory bodies on contract performance and compliance issues against established benchmarks.
• Using both quantitative and qualitative data, proactively identify underperforming or non-compliant providers and recommend and enforce compliance related corrective action(s) when necessary.

4. Regulatory Compliance and Risk Management

• In collaboration with legal and finance teams, ensure contracts are in compliance with established federal, state and local laws and regulations, organizational policies, and financial terms, including fee schedules and reimbursement.
• Identify potential compliance issues and develop recommendations to address risks, improve processes and procedures and maintain compliance with regulatory updates.
• Assist in the development and updating of compliance policies, procedures and training programs for ASO staff as needed to support contract compliance.

5. Team Collaboration

• Contribute positively to a culture of collaboration, results- and customer service-orientations, and professional growth.
• Utilize organizationally sanctioned tools, systems, processes, and methodologies for communication, project management, contracting, skills-building, and other topics.

Qualifications/Experience

• Bachelor’s degree in a relevant field such as Business Administration, Health Administration, Public Administration, Law, Finance or a related field required.
• At least three years of experience in contract management, compliance or regulatory oversight within a behavioral health, Medicaid, managed care or government agency setting.
• Demonstrated expertise in contract law, regulatory compliance, risk management, and behavioral health administration.
• Experience in government contracts, healthcare compliance, contract negotiation and risk management strongly preferred.

Why join us?

• The opportunity to make an impact on the healthcare of Iowans
• On-site work required at least two days per week, with travel across Iowa to support district operations and attend conferences or meetings.
• Great benefits including affordable healthcare plans, dental, vision, 401K with employer match, generous PTO package, paid parental leave, life insurance, and education discounts

Iowa Primary Care Association Core Values

Accountable, Collaborative, Deliberate, Proactive, Respectful, Transformative

Learn more about the Iowa PCA at www.iowapca.org