This role is responsible for the day to day relationships with GHP partners and providers.
This role is responsible for provider recruitment, contracting and relationship management.
This role will help manage the implementation of and all lifecycle activities of a partnership and/or relationship.
This role is responsible for responding to complex inquiries, solving non-routine problems using independent judgment and discretion, and ensuring partner and/or provider satisfaction.
This role will provide support and will act as a technical resource regarding policies, procedures, workflows, complex partner/provider issues and training needs.
MAJOR DUTIES AND RESPONSIBILITIES:
1. *Develops, negotiates and renegotiates contractual and financial arrangements with physician, ancillary and institutional providers.
2. *Collaborates internally with departments such as Sales, QI, Medical Management, Customer Service and claims to align strategic relationship accordingly.
3. *Participates in the development of business objectives for provider relationships consistent with GHP's strategic plans.
4. *Leads and/or participates in development activities throughout both new and existing GHP markets, including tracking and reporting of recruitment activities, progress and barriers to a successful, on-time “go live”.
5. *Develops and executes provider specific strategies, goals and objectives including specialty-specific pay for quality (P4Q) programs and strategy for implementation.
6. *Supports ongoing strategic assessment of provider network.
7. *Ensures all contracts are negotiated in compliance with regulatory requirements and follow all required Health Plan Policies and Procedures related to contract negotiation and implementation.
8. *Leads the creation, implementation and ongoing improvements of negotiation tools reports and analytics.
9. *Coordinates and communicates contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements / relationships.
10. *Provides service-related functions necessary to identify and resolve service inquiries from participating provider network and other healthcare professionals. Documents a detailed account of all provider contacts in the applicable database established and maintained by staff. Accurately records and updates provider information necessary for the ongoing function of various Health Plan operational departments.
11. *Prepares customized orientation programs to educate Health Plan participating providers regarding Health Plan policy and procedure, reimbursement methodology, financial terms and concepts, product lines and associated benefit structure.
*Denotes essential job functions.
COMPETENCIES AND SKILLS:
Demonstrates a comprehensive understanding of complex financial arrangements and quality programs across health care products.
Demonstrates a strong knowledge of the healthcare market.
Demonstrates exceptional financial, analytical and problem solving skills, and understanding of legal documents.
Demonstrates excellent communications skills, written, verbal and presentation.
Ability to work independently and must be self-directed, must also be able to work in team environment to reach goals and objectives
Demonstrates substantive knowledge of managed care policy and direction
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment. Must be willing to independently travel and be willing to accept occasional overnight travel requests. May require evening and weekend work hours.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
Geisinger Health System is an integrated health services organization widely recognized for its innovative use of the electronic health record and the development of innovative care delivery models such as ProvenHealth Navigator® and ProvenCare®. As one of the nation's largest health service organizations, Geisinger serves more than 3 million residents throughout 45 counties in central, south-central and northeast Pennsylvania, and also in southern New Jersey with the addition of AtlantiCare, a National Malcolm Baldridge Award recipient. The physician-led system is comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 12 hospital campuses, two research centers and a 510,000-member health plan, all of which leverage an estimated $8.9 billion positive impact on the Pennsylvania economy. Geisinger has repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research and community service. For more information, visit www.geisinger.org, or follow the latest Geisinger news and more on Twitter and Facebook.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
EDUCATION AND/OR EXPERIENCE:
BA/BS Bachelor's degree required.
Minimum 5 years of contract and network management experience.