Job Summary:Provides ongoing support of providers in the Network model of care delivery. Works directly with the contract management staff to support the departments contracting efforts in acquiring and analyzing providers, drafting contracts and contract templates, creating provider and operations manuals, information gathering, site visit coordination, spreadsheet development and maintenance, problem solving and overall representation of the contracted provider within the organization.Essential Responsibilities:
Develops contract templates. Drafts language for terms and conditions and ensures that the proper review of contracts is obtained. Responds to requests for information regarding standard contract templates and language.
Researches and compares contract rates and maintains files. Develops abstracts of signed agreements. Assists in development, preparation and analysis of RFIs and RFPs. Negotiates and completes letters of agreement under the direction of the Contract Manager.
Serves as a liaison and develops strong relationships between KP, contractors and the network providers. Coordinates provider site visits. Prepares agendas and itineraries and participates in conducting presentations as needed. Organizes and facilitates education and orientation sessions for internal and external audiences. Develops provider operations manuals and educational materials. Responds to questions, information requests and problems from providers. Acknowledges and maintains absolute confidentiality of sensitive information. Fills the role of provider advocate. Leads or supports miscellaneous projects as needed.
Identifies and resolves billing and payment issues within the context of the contract and regulatory agency guidelines. Identifies, researches, and facilitates resolution of operational issues involving the networks. Responsible for the coordination and ongoing monitoring of the credential process to ensure applications are approved in a timely manner.
Conducts research and assists in the coordination and collection of program data.
Creates spreadsheets and maintains them for specific information.
Creates and oversees the maintenance of an organized system of files for contracts and other documents. Collects and organizes sample agreements for easy reference and use.
Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.
Basic Qualifications:
Experience
Minimum three (3) years of experience in healthcare operations in a managed care environment.
Education
Bachelors degree in health care administration, finance, business or related field OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
Competent computer skills including MS Office required.
HTML programming, Web site development skills and familiarity with KP database systems desirable.
Must have strong oral and written communication skills.
Strong analytical and organizational skills also required.
Excellent customer service skills with the ability to make independent judgments, handle multiple projects simultaneously, adapt to shifting priorities and utilize time management skills to meet deadlines.
Team player who works well in a fast paced environment.
Ability to work with a diverse group of people, including physicians, support staff, coworkers and management.
Is tactful and diplomatic.
Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.
Some travel within Northern California service area and/or statewide may be required.
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Experience with medical billing and coding practices, contract administration and credentialing highly preferred.
Experience with network and/or IPA models also preferred.
Project management experience preferred.
Masters degree preferred.
COMPANY: KAISERTITLE: Senior Provider Relations CoordinatorLOCATION: Pleasanton, CaliforniaREQNUMBER: 1341412External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.