Supervisor Provider Contracting Internal Applicants Only

Lets do great things together!

About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.

Position Summary
Provide functional contracting expertise and process oversight to Medical Provider Contractors. Ensure consistency of process across provider teams ensure accuracy and integrity of provider contracts. Support Team Managers in growth and development of staff including workflow processes training programs and policy and procedure development. Represent the team on various projects and committees. Cultivate and maintain professional relationships with providers and practices in assigned territories. The Contracting Supervisor will maintain contracting accountability for a portfolio of high visibility sophisticated provider contracts. This is a FT hybrid position based in Portland Oregon

Pay Range
$92940.40 - $118497.46 annually DOE.
*This role may be classified as hourly (non-exempt) depending on the applicants location. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page linked below to be considered for this position.
Dental Vision Pharmacy Life & Disability

Required Skills Experience & Education:

1. Bachelors degree in Business Finance Health Care Administration or 5 years equivalent work experience in a related field.
2. 2 4 years experience in a supervisory role or equivalent.
3. Minimum 5 years experience in contract negotiation and/or provider reimbursement/revenue cycle.
4. Strong knowledge of provider reimbursement mechanisms including Medicare Medicaid Fee Schedules case rates per diems and risk models.
5. Demonstrated ability to provide and interpret actionable financial operational and quality data to providers and achieve performance goals.
6. Must be able to handle large health system relationships and negotiations.
7. Ability to analyze difficult contracting issues and identify alternative courses of action modify standard contracting procedures and terms to satisfy specialized requirements.
8. Strong verbal written and interpersonal communication skills. Must be able to present and make a business case to Moda Senior Exectives.
9. Ability to work with internal stakeholder departments to create a seamless and positive experience for the provider.
10. Knowledge of medical insurance business as it relates to processing of claims reimbursement policies benefit plans customer service medical management and related information.
11. Strong facilitation skills with the ability to run provider meetings.
12. Excellent communication and interpersonal skills.
13. Strong judgment and decision making skills.

Primary Functions:

1. Create and maintain legal contract templates that are compliant with state and federal regulations and support Modas strategic and financial goals.
2. Develop and maintain contracting policies and procedures that drive efficient and effective operations and are consistent with Modas strategic and financial goals.
3. Performs complex contract negotiations to ensure Modas medical provider networks achieve objectives for unit cost performance access and quality.
4. Perform direct supervision to a team of 2-6 provider contractors. This includes evaluating performance meeting at regular intervals to ensure proper communication and giving coaching as appropriate.
5. Perform first level of review of medical provider contracts to ensure appropriateness of language accuracy of financial terms inclusion of networks consistent with Moda strategy etc.
6. Represent Provider Contractors perspective at Internal Moda meetings.
7. Develop negotiation strategies to achieve business objectives
8. Work with Analytics team to monitor and analyze network and provider performance including Risk Reports and communicate as appropriate to internal decision-makers and to providers.
9. Engage in initiatives impacting the provider experience with Moda which includes but is not limited to: value based care program performance digital initiatives customer service interactions claims processing resolutions and healthcare services programs.
10. Performs other duties as assigned

Working Conditions & Contact with Others:

• Office environment with extensive close PC and keyboard work constant sitting and phone work. Local appointments meetings and social events and some travel throughout the Moda region and/or designated territories (5-20%). Work in excess of 40 hours per week including evenings and occasional weekends to meet business need.
• Internally with many departments including but not limited to: Presentations to Moda Senior Leaders Claims Customer Service and Healthcare Services. Externally with Provider and Hospital Contracting Executives CEOs and CFOs of IPAs and Hospitals Clinic Administrators Business Office Managers Provider Reimbursement Staff Medical Directors Physicians and other Providers.

Together we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.

For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.

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