Provider Services - Supervisor Provider Contracting 115-4000

Tulsa, OK, USA Req #765 Tuesday, March 18, 2025

JOB SUMMARY:

Responsible for the negotiation, execution and implementation of all HMO, PPO and Government Programs, provider contracts including value based and complex. Responsible for the supervision (planning, execution, implementing and monitoring) of all aspects of the provider contracting staff. Responsible for contract related processes and procedures under the direction of the Director, Provider Relations. Responsible for ensuring provider contracting is performed in compliance with all regulatory requirements and accreditation standards.

KEY RESPONSIBILITIES:

• Supervises and facilitates contract negotiations, contract document processes and ongoing deliverables for provider contracts for all assigned product lines as directed by Director, Provider Relations in accordance with all regulatory requirements and accreditation standards. Responsible for oversight of production, documentation, audit, implementation, and ongoing contract deliverables related to contracting process. Ongoing assessment of resource allocation to ensure that the process is working as designed with continual awareness of process improvement opportunities. Operationalize contract related projects assigned by Director, Provider Relations.
• Facilitates and coordinates all value based and complex provider contracting according to and within company guidelines as directed by the Director, Provider Relations. Facilitates reimbursement analysis and recommends provider reimbursement mechanisms. Assists with development of network contracting models including capitation allotment and value-based incentive mechanisms. Develops financial and utilization review report requests. Responsibilities include accurate document development, coordinating with Management and provider, accurate and prompt implementation of all aspects of owned contracts.
• Supervision and development of contracting staff. Participates in the hiring process. Trains, assigns tasks and supports continuing professional development. Evaluate performance and recommend needed personnel actions. Document appropriately. Monitor staffing needs and workflow and recommend changes as needed. Distribute information to subordinates appropriately and in a timely manner to facilitate their job needs. Delegate tasks/projects appropriately to promote personal growth. Model and promote behavior supportive of a teamwork concept.
• Participate in the development of new and existing provider networks to ensure appropriate access and availability for all enrolled lives. Participate in assessing requests and initiating requests for addition of services and providers for all product lines. Participates in the assessment of access and availability of services. Support organizational and departmental goals and objectives related to securing appropriate network panels and budget sensitive reimbursement through timely response to administrative and departmental contract requests and projects.
• Support business operations. Attend information and implementation meetings. Communicate information interdepartmentally and follow through on required action items. Communicate trends and specific incidents impacting company risk management to the appropriate parties. Design and implement policies and procedures contributing to improved efficiency. Monitor departmental compliance to accreditation and regulatory agencies and adjust staffing, policies and procedures as needed. Participate in special projects.

QUALIFICATIONS:

• Ability to process and understand complex information. Ability to organize and oversee multiple complex tasks/projects to completion.
• Ability to coordinate resources in an effective, cost-efficient manner.
• Excellent communication and interpersonal skills.
• Ability to interpret and communicate detailed technical and financial information.
• Demonstrated knowledge of physician and hospital capitation reimbursement methodologies.
• Familiarity with healthcare and managed care business operation environments.
• Strong familiarity with managed care terminology.
• Proficiency with software systems including Amisys, Microsoft Word and Excel.
• Ability to converse and write fluently in English.

EDUCATION/EXPERIENCE:

• Bachelor’s degree plus 3 years work related experience.
• Supervisory experience required.
• Demonstrate through past performance and progressive increased in responsibility, the ability to accomplish goals.
• Excellent oral presentation and writing skills.
• Previous physician/hospital contracting, claims processing, or reimbursement development and auditing experience.
• Familiarity with providers and provider issues in a managed care environment.
• Previous claims software experience, preferably Amisys.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Other details

• Job Family Commercial
• Pay Type Salary

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