Provider Contracting Manager
Posted on: March 18, 2023
HMSA Provider Strategy:
You are responsible for being an active participant in the shaping,
informing, leading, and implementing HMSA's overall corporate
strategy to its providers. You are expected to play an integral
role in supporting, including implementing, various strategic
provider initiatives and working closely with other HMSA
Departments including Office of Payment Transformation, Finance and
Accounting, Medical Management, Medicare and Medicaid Programs,
IHMS, and Market and Product Strategy to coordinate and implement
strategic provider initiatives. These responsibilities include, but
are not limited to, the following:
- Financial Strategy - Aligned with HMSA mission, vision, values
and provider strategy, develop, shape and evaluate financial
proposals being negotiated with providers, including value-based
payment, HMSA's Advanced Hospital Care program, or other
alternative payment models. Work closely with HMSA leadership,
Finance and Accounting, Quality Management, Provider Operations,
Medical Management, Office of Payment Transformation and Corporate
Analytics departments to develop and/or evaluate financial
proposals. Negotiate financial proposals directly with
- Negotiate Contracts - Negotiate standard and nonstandard
agreements with providers by working closely with Legal, Business
Integrity, Provider Operations, Finance and Accounting,
Credentialing, Office of Payment Transformation and other HMSA
departments to ensure that the arrangement reached with each
provider is driving HMSA provider strategy balanced with mitigating
corporate legal, regulatory and operational risks. This includes
reviewing and evaluating redlined contracts, making language
recommendations, negotiating directly with providers and their
agents and being responsible for the overall negotiated arrangement
with the the provider
- Monitor and manage the disbursement of funds for HMSA contract
obligations for non-claims expenses. This includes
programs/projects like strategic community investment funds,
recruiting programs, and bonuses for quality or volume. Evaluate
and communicate with Senior Executives and interested departments
on program effectiveness.
- Provider Partnering - Develop close partnerships with providers
to (1) lead and drive HMSA's mission, vision, values and provider
strategy and (2) facilitate strategic contracting with providers.
Monitor and evaluate status of HMSA relationship with providers to
better inform HMSA provider and contracting strategy. Responsible
for identifying and coordinating, among internal and external
stakeholders, the resolution of provider issues.
- HMSA Internal Partnering - Develop close partnerships with
various HMSA Departments to continuously develop and improve upon
HMSA's provider strategy. At a detailed level, coordinate provider
contractual requirements to ensure appropriate implantation and
administration of provider contracts and negotiated arrangements.
This includes, but is not limited to, (1) working with Finance and
Accounting to ensure adherence to broader HMSA financial
requirements including revenue recognition, pricing and discounting
policies, (2) understanding and evaluating the financial impact of
provider proposals and working closely with Finance and Accounting
to implement contractual requirements, and (3) working with
departments focused on operational, regulatory, and clinical
outcomes to ensure provider contracts meet requirements and render
appropriate, quality, and affordable care to members.
- Maintain contractual records and documentation such as receipt
and control of all contract correspondence, customer contact
information, contractual changes, status reports and other
documents for all projects. Ensure that signed contracts are
communicated to all relevant parties to provide contract visibility
and awareness, interpretation to support implementation. Ensure all
parties comply with contract terms. Ensure contract close-out,
extension or renewal.
- Develop and implement procedures for contract management and
administration in compliance with company policy and to mitigate
risk to company. As appropriate, contribute to or influence company
policies. Develop and prepare regular reports on the status of
contracts and negotiations based on detailed analysis.
- As needed, work directly on corporate initiatives including
strategic provider initiatives, provide guidance on contract
matters to supervisors or other operational staff, including
training to new project stakeholders and other employees in
contracting practices and procedures.
- Performs all other miscellaneous responsibilities and duties as
assigned or directed.
Keywords: HMSA, Honolulu , Provider Contracting Manager, Executive , Honolulu, Hawaii
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