Hybrid Provider Contracting Network Specialist bei Community Health Plan of Washington

Who we are

About the Role

The Network Specialist, Provider Contracting is responsible for maintaining documents and provider contractual status reflected in the Contract Management System including monitoring changes to the provider network.  This role will be actively engaged in network adequacy and system alignment ensuring provider networks are accurately reported to regulatory agencies.

To be successful in this role, you:

• Have a minimum of three (3) years’ experience in document or database management, document control or equivalent experience.
• Have a minimum of two (2) years’ experience in the healthcare industry, preferably working with government agencies and managed care.
• Have familiarity with healthcare provider types.
• Preferred experience with provider networks, provider network adequacy requirements 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.

Essential functions and Roles and Responsibilities:

• Ensures electronic access for all provider contracts and supporting documents. Ensures the Contract Management System aligns with other systems for reporting accuracy and consistencies.
• Responsible for ongoing maintenance of documents within the Contract Management System.
• Ensures status of contractual relationships are kept up to date, complete and accurately reflected in Contract Management System. Research related to requests of contractual status to ensure accuracies and system alignment.
• Responsible for monitoring network changes and impact to network adequacy requirements across all lines of business and informs the Contracting team of any new network gaps.
• Supports Contracting team in identifying potential targets to fill network gaps for all lines of business.
• Responsible for leading Community Health Plan’s Provider Network Adequacy Committee including gathering various data and documents across departments for reporting requirements related to provider network and network development status with regulatory agencies. 
• Responsible for retrieving contracts upon request and as needed for audit purposes.
• Responsible for the implementation of targeted network development and regulatory compliance initiatives requiring contract amendments and revisions.
• 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:

• Have 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.
• Experienced in network development and network adequacy requirements imposed by regulatory agencies having oversite of managed care plans.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office products, including Outlook, Word, Excel, and PowerPoint, Teams.
• Proficient in using collaboration tools such as SharePoint and SmartSheet.
• Effective organizational and time management skills, accurate work results and attention to detail.

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 Non- Exempt and is eligible for overtime. Based on market data, this position grade is 40 (see full range below) and has a 5% annual incentive target based on company, department, and individual performance goals.

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.