Director of Provider Network

Oversee and manage global provider contracting, as well as network rental relationships defined as impacting the entirety of PacificSource’s network enterprise. Manage and update all non-participating provider and default fee schedules for all lines of business across enterprise. Work with various team members and external parties in the completion of various reporting accountabilities and requirements for PacificSource. Work with senior leadership in Health Services, Finance, Sales, Government Programs and IT/Facets Business Support to develop key strategies and participate in collaborative decision making for maximum positive impact and goal achievement across all lines of business. Work collaboratively across teams in Provider Network – as well as maintaining positive business relationships with external contracted vendors and external provider partners.

• Manage “global” contracting processes of those provider types impacting the entirety of PacificSource’s enterprise and across all lines of business, including fee-for-service reimbursement, innovative payment methodologies, and incentive models aligned with PacificSource strategy. Global providers include: Skilled nursing facilities, DME, dialysis providers, orthotics/prosthetics, ambulance, air ambulance, Home Health, Home Infusion, Optical, Vision, transplant vendors, laboratories, hearing aids, rehabilitation/physical therapy and other providers types as may be identified.
• Manage contracting processes with key rental networks impacting the entirety of PacificSource’s enterprise including First Health, FirstChoice Health Network, Zelis, TeleDoc, IPN and others.
• Manage existing and any changes/updates to the company non-participating fee schedule and default fee schedule for all lines of business.
• Manage enterprise capitation payment management, including all PMPM fees and necessary contract modeling, for all lines of business.
• Manage enterprise reporting requirements including: HSD tables for Medicare expansion and annual assessment, NCQA reporting, DSN reporting, Access-to-Care surveying and reporting.
• Manage overall departmental training and documentation functions.
• Manage and oversee key processes pertaining to pre-paid and post-paid contract set up audits for contract implementation across the PacificSource enterprise.
• Responsible for positive departmental culture as it relates to opportunities for improvements in prior department engagement and culture survey results.
• Responsible for oversight, management, development, implementation, and communication of department programs and activities.
• Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-one meetings and performance evaluations for direct reports.
• Develop annual department budgets. Monitor spending versus the planned budget throughout the year and take corrective action where needed.
• Actively participate as a key team member in Manager/Supervisor meetings, as well as PRISM walks and other key department activities. Actively participate in committees as appropriate and in conjunction with other department leaders.
• Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.

Supporting Responsibilities:

• Interact with staff in internal departments such as Finance, Revenue, Health Services, Sales, Communications, IT, AUA, Government Programs and Compliance. Coordinate business activities by maintaining collaborative partnerships with key departments.
• Assess new and innovative provider payment methodologies for approval and implementation.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Work Experience: At least 5 years in healthcare and 3 years in health care contracting, provider relations, or provider network operations required. Some prior management of employees preferred.

Education, Certificates, Licenses: Bachelor’s Degree in related field required.

Knowledge: Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, and reporting, auditing.

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.