Provider Contracting Manager

Company: HMSA
Location: Honolulu
Posted on: March 18, 2023

Job Description:

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:

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• 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 providers.
  
• 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.
  
  Relationsihp Managment:
  
  
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  • 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.
    
    Internal Operations:
    
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    • 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.
      
      Other Duties/Functions:
      
      
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      • 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.
        
        
        
        
        
        
        #LI-Hybrid

Keywords: HMSA, Honolulu , Provider Contracting Manager, Executive , Honolulu, Hawaii