What are the responsibilities and job description for the Contract Coordinator - Hybrid position at Northwest Permanente?

Overview

is seeking a Contract Coordinator in its Provider Contracting & Relations department. This position plays an integral role in the Provider Contracting Department in managing the contract document development process, including production, quality control, execution, signature approval tracking and final retention of documents. This is a critical function to ensure provider contracts produced in the Northwest Region uphold Kaiser Permanente’s fiscal, regulatory, legal, business and reputational needs. In partnership with the Contract Compliance Manager and Provider Contract Managers, this position ensures contract compliance with applicable state and federal regulations and standards, as well as legal, regulatory and accreditation requirements.

PRIMARY RESPONSIBILITES :

Works independently, and with Contract Managers and department leaders to create contract documents which are developed in conjunction with departmental policy, agreed upon financial provisions, care delivery requirements, and legal, regulatory, accreditation and compliance standards.
Ensures departmental contract processes are followed, contracts are developed in accordance with strict guidelines, and final approvals are secured prior to execution, including identifying contracts which require filing with the State of Washington Office of the Insurance Commissioner (OIC), collaborates to draft and refine compensation exhibits and other contract language provisions.
Builds and maintains effective partnerships with network and affiliated practitioners, provider groups, hospital and facility organizations in order to research, collect and maintain key demographic information related to contracts, provider entities, practitioners and locations in the appropriate systems for initial set-up.
Research claims issues including provider not found and provider demographics.
Provides timely and accurate resolution to key constituents to ensure claims are processed in an expedient manner once a claims issue is identified.
Communicates with provider, claims and provider relations personnel and Business Analyst to resolve pending claims.
Determines whether claims received are contracted or non-contracted based on medical services rendered and billed, contractual relationship between rendering and billing provider, scope of contracted services, and configuration detail.
Manages a variety of priority contracting project responsibilities as assigned.
Designs and develops specialized reporting tools related to contract operations and for use by management in the oversight of network development activities.
Communicates with outside providers and facilitates resolution of issues in order to preserve a positive relationship with community providers while insuring a positive KP member experience for services provided by community providers (professional, hospital and ancillary services).
Managing compliance and other departmental projects and initiatives including, but not limited to, facilitation of data gathering for internal audits, state and federal audits and assessments (., CMS, Washington OIC, NCQA), corrective action plans, regulatory bulk amendments, development of reporting and tracking related to contract compliance initiatives.

MINIMUM QUALIFICATIONS :

Bachelor’s degree in business, legal or health care administration or equivalent experience is required.

Minimum three (3) years’ experience in managed care contracting, physician relations or practice management, legal administration, health plan administration, project management, or other comparable office environment providing incumbent the skills necessary for the position.

Proficient in Microsoft Office Products with intermediate computer skills.

Excellent written and verbal communication skills.

Ability to function effectively in a complex, ambiguous, demanding, and rapidly changing environment.

Strong attention to detail. Excellent editing and proofreading skills.

Excellent project management, facilitation, and team building skills. Ability to plan, prioritize and deliver within constrained timelines.

Ability to manage multiple and competing priorities.

Strong critical thinking, listening and independent problem-solving skills.

Ability to exercise a high degree of judgment, discretion, and confidentiality in dealing with sensitive contracting, financial and physician / practitioner personal information to which position has direct knowledge.

Knowledge of relevant laws, regulatory and accreditation requirements and standards.

Ability to work with a diverse group of people both internally and externally, including physicians, support staff, coworkers, management and executive leadership; ability to develop strong interpersonal relationships and use tact, diplomacy, and influence as necessary to achieve desired outcomes.

Position requires a highly self-motivated person who is able to apply judgment in the prioritization of assignments, is organized and efficient in their approach to the work, and is able to work both independently and as a team member in achieving objectives.

Strong customer focus and relationship management skills.

Familiarity with managed care contracting principles and language.

PREFFERED QUALIFICATIONS :

Minimum five (5) years’ experience in managed care contracting, physician relations or practice management, legal administration, health plan administration, project management, or other comparable office environment providing incumbent the skills necessary for the position.

Advanced knowledge of applicable federal and state laws and regulations related to healthcare (in those pertaining to managed care contracting, NCQA, The Joint Commission, Medicare, Medicaid, Washington Office of the Insurance Commissioner).

Experience with medical billing and coding practices, claims adjudication, contract administration (to include the review and drafting of contract language), health plan operations (referrals, prior authorization, product design) and credentialing highly preferred.

Ability to work within and to support a team environment yet work independently completing multiple tasks successfully with minimal supervision. Requires a high level of initiative, sound judgment and the ability to work under pressure in a constantly changing environment balancing multiple priorities.

Ability to work with a diverse group of people both internally and externally, including physicians, management, and executive leadership; ability to develop strong interpersonal relationships and use tact, diplomacy, and influence as necessary to achieve desired outcomes.

High level of computer proficiency in various software applications such as Microsoft office suite (Word, Power Point, Excel), Onyx, Cognos, and Contract Manager.

Strong familiarity with and ability to understand all aspects of a contract document.

Knowledge of health care delivery systems and operations, specific knowledge of Kaiser Permanente medical care delivery operations and systems highly desired.

Ability to synthesize a variety of data to produce a cohesive and well-documented process.

This description is indicative of the general nature and level of work required for this role. It is not designed to contain or be interpreted as a comprehensive description of all duties, responsibilities, and qualifications required of those assigned to this job.

For more information about this position, contact Courtney Johnson,

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