Provider Network Contract Administrator

Who we are
Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Our commitment is to:

• Strive to apply an equity lens to all our work.
• Reduce health disparities.
• Become an anti-racist organization.
• Create an equitable work environment.

About the Role
The Contract Administrator is responsible for developing, maintaining, and expanding our Provider Network. This role will be actively engaged in negotiations with various provider types to ensure the continued delivery of high-quality healthcare services.
To be successful in this role, you:

• Have a minimum of two (2) years of experience in contracting and/or contract management in Managed Care required.
• Have a minimum of four (4) years of experience in contracting and servicing providers in an insurance setting, hospital, Behavioral Health environment, or other clinical settings, including working with physician groups, ancillary providers, and behavioral health agencies preferred.
• Have familiarity with Washington State Provider Networks and managed care operations.
• Have a desire to bring your skills and knowledge to a dynamic team of healthcare professionals and enjoy contributing to offering access to healthcare services for individuals throughout Washington State
• This position may require occasional travel. You must have a current driver's license, an acceptable driving record, and proof of automobile insurance.

Essential functions and Roles and Responsibilities:

• Negotiate hospital, physician groups, ancillary providers, and behavioral health agency contracts, and other provider types as needed.
• Initiate and maintain productive long-term relationships with Provider Networks and other agencies serving Community Health Plan of Washington (CHPW) enrollees.
• Perform contracting negotiation using reimbursement strategies that are aligned with CHPW objectives and meet the needs of the provider communities.
• Develops and uses effective cost and utilization reports for the administration of contracted relationships.
• Ensure provider negotiations and contracts are managed in a way that is complaint with various regulatory agencies, i.e., the Office of the Insurance Commissioner (OIC), Health Care Authority (HCA), and Centers for Medicaid and Medicare Services (CMS).
• Assures maintenance of accurate, current, detailed files with important provider information.
• Proactively identifies and addresses gaps in the Provider Network to improve member access and meet CHPW's network adequacy and regulatory requirements.
• Communicate proactively and effectively with internal and external business partners.Participates and reviews CHPW's policies and procedures that impact provider
• relations and contracting.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Knowledge of various reimbursement strategies and methodologies used by State and Federal programs such as Washington State Health Care Authority and Centers for Medicaid and Medicare Services.
• Knowledge of network development and network adequacy requirements imposed by regulatory agencies having oversite of managed care plans.
• Excellent oral and written communication skills.
• Skilled in the use of Microsoft Office products, including Outlook, Word, Excel, and PowerPoint.
• Skilled in the use of collaboration tools such as Microsoft Teams, SharePoint, and Smartsheet.
• Ability to organize work and the ability to focus on detail.
• Ability to meet scheduled deadlines with minimal supervision.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn't perfectly check every box in the job description, we encourage you to apply anyway.
As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History:includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:
The position is FLSA Exempt and is not eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors.
CHPW offers the following benefits for Full and Part-time employees and their dependents:

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year.
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

Sensory/Physical/Mental Requirements:
Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.
• Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

Mental:

• Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.

Work Environment:
Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)