USA

CONTRACT COMP SPEC - PROVIDER NETWORK OPERATIONS

Albuquerque - New Mexico (NM), 87113

Presbyterian Healthcare Services

Job Description:

Job Description
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Days

Summary:
Major duties include, but are not limited to, managing the necessary requirements and documentation to ensure compliance with PHP Legal, Compliance, NCQA, and Government Programs as the department liaison. This position involves a high degree of personal interaction with the Manager of Contracting, as well as network providers and other health plan staff.
Responsibilities:
  • Provides management and compliance support for contracting and serves as point of contact for Presbyterian Legal, Presbyterian Sales department, New Mexico HSD, CMS, OSI, HEDIS, NCQA, business partners for other audits or reviews as the items relate to provider contracts.
  • Responsible for projects around development of provider communication and contractual documents when necessary, which includes but is not limited to the PresConnect approval, address validation extraction, and point of contact for the coordination with the mail room as well as contractual management system upload and validation of provider receipt.
  • Responsible for managing assigned Project Plans on time and on schedule, which includes but is not limited to the use of project management tools and techniques to develop work plans, tasks, timelines, and measurements for all project assignments. Provides accurate and timely reports on project progress, identifying risks and opportunities and escalating as appropriate. Directs project through full lifecycle, including project initiation and requirements definition, planning, execution, monitoring, and project closure.
  • Responsible for participation in assisting leadership with identifying and developing project plans for internal process improvement and implementation of contractual initiatives.
  • Contributes to the
department s strategic mission by exhibiting the high standards of project management competence and seeking opportunities for continuous improvement at the project, team, and organizational level.
  • Manages and completes special project requests from the management team.
  • Responsible for maintaining contract templates used by contracting staff, which includes but is not limited to verification on current regulation and policy references within contract as well as periodic additions throughout the year to ensure compliance with newly identified requirements.
  • This position will provide project management for complex and strategic department projects. Direct the team through definition, development, and implementation of critical processes and systems solutions and interacts directly with health plan staff, as well as regulatory agency staff and external auditors as needed.
  • This position involves a high degree of personal interaction with the management team, as well as network providers and other health plan staff.
  • Requirements:
    Associates Degree plus three to five years experience in healthcare. Three to five years of experience in provider relations, provider contracting, or customer service in a healthcare organization. Superior oral, written, interpersonal skills required to interface with internal and external customers

    • Three to five years experience in provider relations and customer service in a managed care organization or equal experience.
    • Must demonstrate strong analytical skills and detail-oriented skills with regards to data analysis reports.
    • Must demonstrate strong verbal and written communications skills with strong interpersonal and negotiations skills.
    • Must also have a strong working knowledge of Microsoft Office products and other personal computing skills.
    • Accuracy and attention to detail are crucial.

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