Provider Services Supervisor

Provider Services Supervisor

The Provider Contract Supervisor is responsible for overseeing the negotiation, analysis, and implementation of hospital, provider, and ancillary provider agreements as well as single case agreements across all lines of business. This role entails supervising a team of contract specialists, providing guidance and performance evaluations, ensuring compliance with regulatory requirements, and enhancing contract management to ensure department goals are met. This role will require strong leadership skills, a detail-oriented and precise approach to contract language review, cross collaboration with other teams and providers, and a process-driven approach to contract management.

Position overview

Essential Functions:

• Supervise and lead provider contracting within Provider Services and across departments, including recruitment of new providers, re-negotiating existing agreements, and timely implementation of new contracts.
• Oversee the maintenance of all Provider Contract templates. Review new regulatory requirements and APLs; work with the Compliance Department as needed to modify contract templates to ensure compliance with all contractual and regulatory requirements. 
• Keep internal policies, procedures and workflows related to provider contracting up to date, including through the analysis of new or updated regulations and by implementing appropriate changes as needed.
• Lead efforts to increase the knowledge of other HPSM departments about contract requirements that apply to HPSM and its provider network.
• Serve as department lead on maintenance and configuration of the provider contract database and related processes; oversee efforts to identify and implement improvements to the contract pipeline processes.
• Function as a liaison between HPSM and select providers as assigned; this may include managing relationships with hospitals, health systems, and ancillary providers, assisting in resolving complex payment issues, and identifying and implementing process improvements.
• Support HPSM network adequacy compliance, implementing corrective action as needed throughout the year to improve network performance and support regulatory submissions.
• Participate in internal and external stakeholder meetings as needed related to provider contract language, provider payment, and other regulatory requirements.
• In coordination with the Finance and Claims Department, support the development of financial impact analysis/modeling on new and revised payment arrangements. Ensure reimbursement and payment agreements are configured appropriately in claims system, in collaboration with the Claims and IT Configuration department.
• Support audit activities and regulatory reports for NCQA, DMHC, DHCS, and CMS as needed.

• Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.  Complete performance evaluations in a timely manner.

Secondary Functions:

• Collaborate with other departments on projects requiring provider contracting expertise as needed.
  
  
• Perform other duties as assigned.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply. 

Education and experience are equivalent to:

• A Bachelor’s degree or equivalent education in a related field; and an advanced degree is a plus.
• Minimum of five (5) years managed care provider contracting experience, including three (3) or more years in a lead capacity.

Knowledge of:

• Medicare and Medicaid markets include regulations and requirements. Includes strong knowledge of Managed Medicare and Managed Medicaid.
• Health plan contracting norms and contract writing.
• Health plan payment methodologies, as well as provider billing and payment processes.
• Medicaid and Medicare reimbursement methodologies
• Fee schedule development, utilizing financial models and analysis in developing provider payment rates and risk-sharing arrangements.
• Knowledge of project management and process improvement methodologies.
• Quantitative reasoning and analytic tools.
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint, and content management tools.

Ability to:

• Establish and maintain cooperative working relationships across departments and with external providers.
• Communicate effectively, verbally and in writing.
• Handle complex issues with diplomacy.
• Works cross-functionally to execute network quality goals.
• Maintain accountability for regulatory compliance, often on short timeframes.
• Work cross-functionally to execute network quality goals.
• Influence others both with and without authority.

Salary and benefits

The starting salary range is $92,240 - $118,485 annually, depending on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

It is HPSM's policy to provide equal employment opportunities for all applicants and employees.  HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law.  HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.