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PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Responsible for providing strategic oversight for designated complex provider partnerships, positively impacting operational efficiencies, cost, quality, and improved health outcomes. Work collaboratively with other PacificSource stakeholders and external partnership representatives, such as physicians, executive management, JOC work stream leaders (Quality, Health Services, IT, Analytics, Risk Adjustment, Pharmacy), and clinical/office staff, to create a plan of collaboration, implementation and success for JOC initiatives. Ensure consistency and collaboration with providers and internal stakeholders, as well as serve as a primary point of contact for JOC facilitation. This position works to build/strengthen relationships with strategic provider partners by ensuring effective education, analyzing and generating specific reports, and proactively identifying improvement opportunities that support PacificSource’s strategic goals. This position also assists with the development and execution of region-specific strategies and coaching.

Essential Responsibilities:

• Manage for ongoing or to completion: initiatives, activities and projects resulting from partner and PacificSource identified opportunities, with engagement across all lines of business.
• Provide ongoing training, coaching and high-touch support to network system providers and staff toward the development and implementation of improvement activities to support process improvement from PacificSource and external partner.
• Collaborate with multiple departments to develop and deploy aligned initiatives, process improvement activities, and enhance workflows to improve provider partner satisfaction and streamline processes for better member care outcomes and service.
• Track project progress and communicate to JOC participants and other stakeholders; develop and manage JOC schedule; timelines, activities, and milestones.
• Provide direct provider support through contracting auditing, working as a liaison with internal departments to support improved processes with claims processing, facilities, group and provider set up.
• Provide education to applicable Providers on PacificSource products, administrative procedures, legislative, and compliance requirements.
• Work directly with Provider Network and other departmental leadership to advance JOC initiatives, working closely with other work stream leaders including Contracting, Health Services, Pharmacy, Analytics, IT, Population Health and Risk Adjustment.
• Work with internal stakeholders and business owners to present and review data and deliver provider reporting packages. Assist in identifying opportunities/trends, tools, and proposed course of action to help meet incentive, quality, and operational goals as appropriate.
• Work with consultants and various areas of hospital(s) - finance, clinic managers, billing supervisory staff, Utilization, Credentialing -to develop a strategic direction based off of current processes and opportunities. Create and help execute a collaborative roadmap to accomplish established goals.
• Prepare materials and presentations for meetings, with the assistance of the Provider Relations Representative, Quality Coordinator, and other applicable personnel. Conduct/participate in group operational meetings.
• Receive, analyze, and respond to provider issues and assure timely, appropriate follow-up. Work to identify potential trend issues and seek resolution(s).
• Serve as a provider contact and problem solver for a wide range of issues including, but not limited to; claims, operational, encounter, quality, risk provider, clinic, billing, health services notifications, capitation/financial, contractual details and any data/reporting needs.

Supporting Responsibilities:

• Understand contracting methodologies and terms for all lines of business.
• Proactively develop positive working relationships with other PacificSource departments and staff to resolve provider issues.
• Develop thorough knowledge of system capabilities related to Facets setup, Facets Business Support, other supporting systems.
• Exercise independent judgment and communicate effectively between internal and external team members.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Maintain clear understanding of system set-up and reporting requirements/limitations as required by contractual obligations.
• Participate in provider specific and public presentations as required.
• Assist in leading, shaping and developing special projects related to PacificSource initiatives.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of 5 years’ experience in the health insurance industry, provider organization or associated field related to partnership building. A thorough understanding of services and processes, administrative procedures, government compliance, and the health insurance industry is required. Demonstrated experience in several of the following areas: managing complex projects, ability to develop and execute strategy, ability to understand provider contracts and impacts, process improvement, data analysis and reporting. Demonstrated skills to facilitate, implement, and measure improvement projects strongly desired.

Education, Certificates, Licenses: BA or BS in business, health care administration, finance, or equivalent work experience desired. Experience in Project Management preferred.

Knowledge: Knowledge of coding methodologies required. General understanding of financial arrangements and quality programs across health care products. A thorough understanding of products, contracts, administrative procedures, and the health insurance industry’s legal and mandatory guidelines preferred. Ability to remain current on PacificSource administrative procedures and products, healthcare, and the health insurance industry. Excellent communication skills, both verbal and written. Ability to communicate effectively with all types of individuals. Excellent public relations skills and public speaking ability. Ability to effectively explain plans and administration to groups of varying educational backgrounds and familiarity with benefits. Ability to effectively communicate with various internal departments. Ability to provide prompt, professional, and courteous service to customers, producers, and PacificSource employees. Ability to work in a fast-paced environment, managing shifting priorities and multiple tasks simultaneously. Superior work leadership skills, including taking action without specific direction. Requires a high level of integrity and trust, given frequent exposure to confidential material. Demonstrated ability to remain resilient, flexible, and focused in a changing environment. Work autonomously and independently. Desire to learn new things, anticipate problems, and develop contingency plans to manage them. Proficient in Microsoft Word, Excel, PowerPoint, and Outlook.

Competencies:

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25-50% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range:

$65,296.83 - $111,004.62

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.

• We are one team working toward a common goal.

• We are each responsible for customer service.

• We practice open communication at all levels of the company to foster individual, team and company growth.

• We actively participate in efforts to improve our many communities-internally and externally.

• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.