Location: Portland, Oregon
This position plays an intergal role in managing the contract document development process, including production, quality control, execution, signature approval tracking and final retention of documents. This is a critical function to ensure provider contracts produced in the Northwest Region uphold Kaiser Permanente's fiscal, regulatory, legal, business and reputational needs. In partnership with the Contract Compliance Manager and Provider Contract Managers, this position ensures contract compliance with applicable state and federal regulations and standards, as well as legal, regulatory and accreditation requirements.
This position initiates all credentialing and privileging requirements with external contracted physician and facility providers and works in conjunction with the Regional Quality Resource Management Department to ensure credentialing/delegation and recredentialing are completed prior to execution of contracts. Position advocates for delegated credentialing, wherever feasible, to lessen the administrative burden to KPNW and hospital and medical group providers in the credentialing process. Provider's successful completion of credentialing prior to the execution of the contract is necessary to warrant provider's compliance with state, federal, accrediting and NCQA requirements, and is critical to ensuring patient safety, and to mitigate any potential risk to KFHP-NW, KFH, and NWP.
The Contract Coordinator is responsible for the effective and accurate administration of all contract and provider demographics for the NW Region. He/she is responsible for ensuring integrity of provider demographics, and is accountable for securing, managing, and maintaining all external physician and facility provider demographics which feed critical downstream patient care, financial and referral systems, including EPIC/HealthConnect, Pharmacy, Credentialing, Referrals, Provider System of Record (PSR), provider directories including KP.org, and Tapestry/Claims. The NW Region is required to demonstrate to regulators (e.g., CMS, OIC, and the Oregon Insurance Division) an adequate network of providers that are compliant with regulatory and other oversight and accreditation agency standards. The provider demographics managed by this function is foundational to the development, maintenance and reporting required of KPNW to demonstrate its network adequacy.
Additionally the Contract Coordinator is responsible for researching and collating information regarding individual primary and specialty care providers, provider groups, ancillary, skilled nursing, home health, ASC's and hospital facilities available in designated geographic areas, in an effort to assist KPNW Contracting, Operations and Care Delivery teams in identifying services and providers potentially to be targeted for contracting, in order to meet Care Delivery and Network Adequacy requirements in geo expansion areas (e.g., Lane County).
This is a hybrid position that is a blend of working both remotely and in office. Must reside in the Northwest Service Region (Oregon or Washington).
Join Our Medical Group
Northwest Permanente is a self-governed, physician-led, multi-specialty group of 1,500 physicians, surgeons, and clinicians, caring for 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.
Major Responsibilities / Essential Functions
- Works independently, and with Contract Managers and department leaders to create contract documents which are developed in conjunction with departmental policy, agreed upon financial provisions, care delivery requirements, and legal, regulatory, accreditation and compliance standards. Ensures departmental contract processes are followed, contracts are developed in accordance with strict guidelines, and final approvals are secured prior to execution, including identifying contracts which require filing with the State of Washington Office of the Insurance Commissioner (OIC), collaborates with the Provider Contract Managers, Director Provider Contracting, or Senior Director to draft and refine compensation exhibits and other contract language provisions. Works closely with the Contract Compliance Manager, Regional Contract Managers, and National Provider Contract Managers and staff to insure timely filing of contracts with the Washington OIC.
- Builds and maintains effective partnerships with network and affiliated practitioners, provider groups, hospital and facility organizations in order to research, collect and maintain key demographic information related to contracts, provider entities, practitioners and locations in the appropriate systems. The accuracy and availability of this data is critical in ensuring functionality and credibility of multiple downstream systems (Claims, Pharmacy, Credentialing, HealthConnect, Referrals, Provider System of Record, KP.org). May assign and train other staff (e.g., temp or permanent provider data specialists, department admin.) in the development and maintenance of provider demographics. In addition, the position works closely with the Regional Quality Resource Management Department to initiate the credentialing and privileging process for external contracted medical facilities, physicians, practitioners and other medical professionals to ensure that all credentialing and organizational assessment requirements are met prior to execution of provider contracts. The data integrity and credentialing is critical to ensuring patient safety and that the needs and standards of finance, regulatory, provider directories, network adequacy and other business interests are met.
- Researches claims issues including provider not found and provider demographics. Provides timely and accurate resolution to key constituents to insure claims are processed in an expedient manner once a claims issue is identified. Communicates with provider, claims and provider relations personnel and Business Analyst to resolve pending claims. Determines whether claims received are contracted or non-contracted based on medical services rendered and billed, contractual relationship between rendering and billing provider, scope of contracted services, and configuration detail.
- Manages a variety of priority contracting project responsibilities, as assigned by the Sr. Director or Director, Provider Contracting, Mgr., Contract Compliance and Operations, and/or his/her designee. Examples include researching and evaluating potential providers available to meet Care Delivery requirements in market expansion areas, (e.g., KP's network expansion in Lane County), developing provider reimbursement/statistical reports from Cognos, or specialized reporting for purposes of informing leadership of high priority project status. Designs and develops specialized reporting tools related to contract operations and for use by management in the oversight of network development activities.
- Communicates with outside providers and facilitates resolution of issues in order to preserve a positive relationship with community providers while insuring a positive KP member experience for services provided by community providers (professional, hospital and ancillary services). Appropriately confers, collaborates with and escalates complex issues to appropriate staff persons within Provider Contracting and Relations or outside departments.
- Collaborates with Contract Compliance Manager, Director and Sr. Director, Provider Contracting and Relations in managing compliance and other departmental projects and initiatives including, but not limited to, facilitation of internal audits, state and federal audits and assessments (e.g., CMS, Washington OIC, NCQA), corrective action plans, regulatory bulk amendments, development of reporting and tracking related to contract compliance initiatives, and network adequacy.
Minimum Work Experience
Minimum three (3) years experience in managed care contracting, physician relations or practice management, legal administration, health plan administration, project management, or other comparable office environment providing incumbent the skills necessary for the position.
- Proficient in Microsoft Office Products with intermediate computer skills.
- Excellent written and verbal communication skills.
- Ability to function effectively in a complex, ambiguous, demanding, and rapidly changing environment.
- Strong attention to detail. Excellent editing and proofreading skills.
- Excellent project management, facilitation, and team building skills. Ability to plan, prioritize and deliver within constrained timelines
- Ability to manage multiple and competing priorities.
- Strong critical thinking, listening and independent problem solving skills.
- Ability to exercise a high degree of judgment, discretion, and confidentiality in dealing with sensitive contracting, financial and physician/practitioner personal information to which position has direct knowledge.
- Knowledge of relevant laws, regulatory and accreditation requirements and standards.
- Ability to work with a diverse group of people both internally and externally, including physicians, support staff, coworkers, management and executive leadership; ability to develop strong interpersonal relationships and use tact, diplomacy, and influence as necessary to achieve desired outcomes.
- Position requires a highly self-motivated person who is able to apply judgment in the prioritization of assignments, is organized and efficient in their approach to the work, and is able to work both independently and as a team member in achieving objectives.
- Strong customer focus and relationship management skills.
- Familiarity with managed care contracting principles and language.
- Ability to maintain confidentiality of highly sensitive information, e.g., KP's strategic initiatives with outside Health System's sometimes with access to information protected under a Non-Disclosure Agreement.
- Ability to perform in a fast paced environment with competing priorities on a daily basis. Due to the demands placed on the Provider Contracting and Relations Department, the pace in the department is rapid and dynamic, sometimes causing project priorities to rapidly and significantly shift. The Contract Coordinator must be flexible, adaptable, and able to meet deadlines under pressure.
- Bachelor's degree in business, legal or health care administration.
Preferred Work Experience and Qualifications
- Minimum five (5) years experience in managed care contracting, physician relations or practice management, legal administration, health plan administration, project management, or other comparable office environment providing incumbent the skills necessary for the position.
- Advanced knowledge of applicable federal and state laws and regulations related to healthcare (in particular those pertaining to managed care contracting, NCQA, The Joint Commission, Medicare, Medicaid, Washington Office of the Insurance Commissioner).
- Experience with medical billing and coding practices, claims adjudication, contract administration (to include the review and drafting of contract language), health plan operations (referrals, prior-authorization, product design) and credentialing highly preferred.
- Ability to work within and to support a team environment, yet work independently completing multiple tasks successfully with minimal supervision. Requires a high level of initiative, sound judgment and the ability to work under pressure in a constantly changing environment balancing multiple priorities.
- Ability to work with a diverse group of people both internally and externally, including physicians, management, and executive leadership; ability to develop strong interpersonal relationships and use tact, diplomacy, and influence as necessary to achieve desired outcomes.
- High level of computer proficiency in various software applications such as Microsoft office suite (Word, Power Point, Excel), Onyx, Cognos, and Choreo.
- Strong familiarity with and ability to understand all aspects of a contract document.
- Knowledge of health care delivery systems and operations, specific knowledge of Kaiser Permanente medical care delivery operations and systems highly desired.
- Ability to synthesize a variety of data to produce a cohesive and well-documented process.
Equal Opportunity Employer
At Northwest Permanente, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente believes that equity, inclusion, and diversity among our employees are critical to our success, and we seek to recruit, develop, and retain the most talented people from a diverse candidate pool.