Kaiser Permanente Contract Manager in Aurora, Colorado
Negotiates, implements and maintains contracts with outside providers and vendors in the areas of hospitals, professional, ancillary, skilled nursing facilities, and other technical services that are cost effective and deliver quality services. Primarily responsible for the management of the relationships with key medical groups, hospitals, and ancillary providers as assigned. Maintain and support a culture of compliance, ethics and integrity. Responsible for ensuring ongoing compliance for External Medical Services. Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to External Medical Services.
Essential Functions: - Negotiates with external providers/vendors for development and implementation of contracts. - Interacts with internal departments pursuant to contract development/implementation. - Maintains relations with contract providers. - Analyzes perspective payment amounts related to offering of new/existing contracts. - Writes and modifies contractual agreements to match the type of provider/vendor, e.g. hospital , ASC, mental health and/or equipment. - Resolve incoming escalated provider inquiries related to claims, credentialing, and member complaints. - Reviews key contract provisions with Medical Group and Health Plan staff and obtains buy-in and approval of key provisions. - Coordinates implementation/administration of new contracts and coordinates administration of existing contracts; resolves contractual issues. - Act as a main contact for education as well as a liaison between the provider and the health plan to present, promote, and resolve clinical and administrative concerns of provider.
Qualifications: Basic Qualifications: Experience - Minimum two (2) years of health care experience involving quantitative and financial analysis, negotiating contracts, and health care billing/claims. Education - Bachelor's degree in business, health care administration 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: - Working knowledge of budget management, claims processing, medical coding and contract language/reimbursement models. - Ability to work with computers for data retrieval and design, and use of financial analysis models. - Highly effective negotiation and written communication skills.
Preferred Qualifications: - N/A
COMPANY Kaiser PermanenteTITLE Contract ManagerLOCATION Aurora, COREQNUMBER 618917
External 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.