Mgr Provider Contracting
The Southeast Permanente Medical Group, Atlanta, Georgia, United States, 30383
The Southeast Permanente Medical Group, (TSPMG)/ Kaiser Permanente is happy to announce an opening for a
Manger of Provider Contracting .
Description:
This position reports to the Director of Provider Contracting & Network Management to support the contracting activities of (TSPMG) the Medical Group. Contracting activities continue to grow substantially in volume, financial impact, and complexity. Existing contracts must be continually renegotiated and aggressively managed. The Manager of Provider Contracting is expected to negotiate, renegotiate, and manage contracts that should result in significant reduction of outside medical expense for Kaiser Permanente Health Plan. Areas of responsibility will include IPAs, PHOs and other physician services. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care; and a minimum of 5 years of negotiation in PHO/IPA and various physician services.
Job Functions: Successfully negotiate contracts for cost reduction or contract and relationship maximization with specialty service providers. This includes individuals, networks, using a diverse range of techniques and contracting best practices'', to include value base, capitation, case rates, and various fee for services arrangements. Execute and manage multiple expansion related priorities for Region. Develop, manage and implement Region-wide contracting strategies. This includes specialty services and the alignment of contract interests of TSPMG, Health Plan, and Network providers. Manage contractual relationships and ensure accurate administration of contract terms. Lead and participate in multidisciplinary teams comprised of contracted provider representatives and KP representatives. Provide ongoing intervention and assistance in the management of claims, UM and benefit issues. Work with QRM, Claims, Health Plan, Contracts and Benefits and other internal departments as needed to ensure KP and provider understanding of and adherence to contractual obligations and intent. Collaborate with Performance Analysis to identify cost savings initiatives and monitor contract performance. Ensure contract compliance with all requirements as set forth by State and Federal agencies. Work closely with QRM to identify out of network providers. Supervise and execute special projects assigned by Director. Manage and mentor employees to successfully support the goals of the organization.
Minimum Experience and Education: Bachelor's degree
BS/BA in business administration, finance or healthcare MBA or MHA preferred
9-10 years work experience in the healthcare industry Preferred Experience and Education:
With minimum of 8-10 years' experience in the healthcare industry Strong Negotiation Skills Ability to budget and obtain necessary medical cost targets Requires a strong understanding of financial reports and the ability to manage accordingly Require understanding contract language and legal requirements for contracting A broad-based knowledge of healthcare and the various medical delivery systems Understanding of various financial reimbursement methodologies used in managed care contract is required Negotiation, analytical skills and human interaction skills are necessary Excellent organizational and prioritization skills, the ability to work under tight deadlines, and high productivity are required Value Base Contracting Network Adequacy Reporting Strong Written and excellent communication skills
The Southeast Permanente Medical Group (TSPMG) is one of Georgia's largest independent, physician-owned, multi-specialty medical groups. More than 600 physicians and 200 associate practitioners work together in a unique integrated care modelto provide high-quality care to over 315,000 Kaiser Permanente members. Care is delivered at 26 medical offices featuring state-of-the-art equipment, labs, imaging services, and pharmacies. We also provide surgical services and around the clock care at some of the area's top hospitals.
TSPMG offers a competitive salary, a generous retirement package, paid time off, health, dental, vision, and life insurance, long and short-term disability, relocation allowance, and more. We also offer numerous clinical and non-clinical learning opportunities and physician leadership development.
Atlanta, our home for more than 30 years, is a thriving metropolis that blends southern charm with modern art, music and culture. Learn more aboutour beautiful southern city at www.atlanta.com.
We are an equal opportunity employer. All applicants will be considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status. We maintain a drug and nicotine free workplace and perform pre-employment substance abuse testing.
Manger of Provider Contracting .
Description:
This position reports to the Director of Provider Contracting & Network Management to support the contracting activities of (TSPMG) the Medical Group. Contracting activities continue to grow substantially in volume, financial impact, and complexity. Existing contracts must be continually renegotiated and aggressively managed. The Manager of Provider Contracting is expected to negotiate, renegotiate, and manage contracts that should result in significant reduction of outside medical expense for Kaiser Permanente Health Plan. Areas of responsibility will include IPAs, PHOs and other physician services. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care; and a minimum of 5 years of negotiation in PHO/IPA and various physician services.
Job Functions: Successfully negotiate contracts for cost reduction or contract and relationship maximization with specialty service providers. This includes individuals, networks, using a diverse range of techniques and contracting best practices'', to include value base, capitation, case rates, and various fee for services arrangements. Execute and manage multiple expansion related priorities for Region. Develop, manage and implement Region-wide contracting strategies. This includes specialty services and the alignment of contract interests of TSPMG, Health Plan, and Network providers. Manage contractual relationships and ensure accurate administration of contract terms. Lead and participate in multidisciplinary teams comprised of contracted provider representatives and KP representatives. Provide ongoing intervention and assistance in the management of claims, UM and benefit issues. Work with QRM, Claims, Health Plan, Contracts and Benefits and other internal departments as needed to ensure KP and provider understanding of and adherence to contractual obligations and intent. Collaborate with Performance Analysis to identify cost savings initiatives and monitor contract performance. Ensure contract compliance with all requirements as set forth by State and Federal agencies. Work closely with QRM to identify out of network providers. Supervise and execute special projects assigned by Director. Manage and mentor employees to successfully support the goals of the organization.
Minimum Experience and Education: Bachelor's degree
BS/BA in business administration, finance or healthcare MBA or MHA preferred
9-10 years work experience in the healthcare industry Preferred Experience and Education:
With minimum of 8-10 years' experience in the healthcare industry Strong Negotiation Skills Ability to budget and obtain necessary medical cost targets Requires a strong understanding of financial reports and the ability to manage accordingly Require understanding contract language and legal requirements for contracting A broad-based knowledge of healthcare and the various medical delivery systems Understanding of various financial reimbursement methodologies used in managed care contract is required Negotiation, analytical skills and human interaction skills are necessary Excellent organizational and prioritization skills, the ability to work under tight deadlines, and high productivity are required Value Base Contracting Network Adequacy Reporting Strong Written and excellent communication skills
The Southeast Permanente Medical Group (TSPMG) is one of Georgia's largest independent, physician-owned, multi-specialty medical groups. More than 600 physicians and 200 associate practitioners work together in a unique integrated care modelto provide high-quality care to over 315,000 Kaiser Permanente members. Care is delivered at 26 medical offices featuring state-of-the-art equipment, labs, imaging services, and pharmacies. We also provide surgical services and around the clock care at some of the area's top hospitals.
TSPMG offers a competitive salary, a generous retirement package, paid time off, health, dental, vision, and life insurance, long and short-term disability, relocation allowance, and more. We also offer numerous clinical and non-clinical learning opportunities and physician leadership development.
Atlanta, our home for more than 30 years, is a thriving metropolis that blends southern charm with modern art, music and culture. Learn more aboutour beautiful southern city at www.atlanta.com.
We are an equal opportunity employer. All applicants will be considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status. We maintain a drug and nicotine free workplace and perform pre-employment substance abuse testing.