Provider Relations Executive

Provider Relations Executive
Must reside in WA - Teleflex Option




Primary Job Purpose


Manages the full provider experience for assigned providers (excluding contracting and negotiation of fee-for-service reimbursement rates and terms), including education, communication, VBA performance, vendor integration into the provider network, and rapport/engagement to build and maintain strong long-term relationships with assigned providers. Drives healthcare transformation to improve quality, cost and consumer/provider experience by working with key strategic provider partners to enable their success in Cambias value-based arrangements (VBAs) and innovative initiatives as well as develop relationships and capabilities for future value-based arrangements. Manages cross-functional, cross-departmental relationships in support of effective provider partnerships and maintenance of network stability and adequacy.
Responsibilities

Develops and fosters collaborative, productive and professional external partnerships with key providers and internal stakeholders. Brings value and establishes credibility as a trusted advisor and resource to influence positive change while imparting a positive company image and professional demeanor.

Documents information key to the provider relationship in the documentation platform. Tracks and reports performance on provider engagement and other metrics. Works with internal stakeholders to ensure providers have access to reports and tools to drive performance.

Maintains detailed knowledge of all value-based arrangements, including contract terms and performance targets, and educates providers and other internal stakeholders.

Facilitates executive-level Joint Operating Committees with providers to discuss performance success and roadblocks, roadmaps for improving performance, and new collaboration opportunities.

Facilitates internal and external work groups to review performance reports, identify opportunities and drive action plans to progress towards improved outcomes for clinical quality, cost containment, improved member experience, and enhanced provider experience.

Drives provider engagement in strategic health plan programs, including Medicare Advantage (MA) HMO activities, MA Quality Incentive Program with assigned provider groups, and adoption of new tools and technology. Coaches provider and promotes the focused use of available resources and tools to improve member health outcomes through provider engagement and enablement. Monitors progress and communicates performance and expectations needed to result in better member health outcomes and efficiencies for the provider and Cambia to drive change.

Identifies and leads new initiatives that assist providers in transitioning from Fee for Service payment and using innovative payments that promote improvements in quality, cost and member experience.

Manages the implementation of cross functional organizational strategies, including utilization management, provider data improvements, contracting - focusing on improving the provider experience and member experience and resolution of issues that may impede successful execution of strategies. Ensures provider outcomes goals are aligned with internal strategies.

Develops and facilitates education and training programs for providers and acts as external point of reference on policies.

Maintains extensive knowledge of clinical performance levers across all lines of business, such as care gaps, Medicare STARS, and HCC coding; works closely with clinical partner on clinical improvement opportunities.

Serves as a subject matter expert on competitive intelligence regarding the provider landscape, network performance, value-based care, and cost containment efforts for assigned territory and/or account(s).

Supports development of new value-based arrangements and other innovative programs and initiatives to drive healthcare transformation.

Attends meetings externally, as assigned, with the ability to represent the health plans position on local and national provider programs.

May occasionally coordinate to resolve escalated provider claims and/or operations issues that may involve internal and external meetings.
Requirements

Deep knowledge and understanding of the provider community and principles of healthcare delivery systems.

Strong communication (written and verbal) and facilitation skills with ability to deliver challenging messages with diplomacy while maintaining strong and trusting relationships with provider partners. Ability to interpret policies and procedures and explain effectively to stakeholders.

Self-directed with creative problem-solving skills including the ability to identify problems, develop and recommend solutions, and implement a chosen course of action to resolve issues and build consensus among groups of diverse stakeholders.

Professional presence, leadership, and knowledge of helping complex organizations affect change to improve their operations.

Strong critical thinking, consulting, and influencing skills at all levels of the organization, both internally and externally, as well as the ability to present complex information simply and succinctly.

Demonstrated ability to effectively manage a variety of formal presentation settings; one-on-one, small and large groups and with peers; is effective both inside and outside the organization.

Demonstrated ability to take initiative, prioritize work and meet timelines.

Knowledge of provider coding, reimbursement, contract methodologies, products and networks. Understanding of value-based arrangements.

An understanding of the inputs to the total cost of care for a population, including unit cost, utilization, and other claims costs.

Ability to work in a high-pressure environment and effectively manage conflict and ambiguity.

Proficiency in using Microsoft Office tools, including Word, Excel and Powerpoint. Familiar with health care systems and infrastructure such as provider file and claims.

Ability to travel extensively within the state.


Normally to be proficient in the competencies listed above


Provider Relations Executive would have a Bachelors degree in Healthcare Administration or related field and a minimum of 5 years of experience in the healthcare industry with specific focus in provider relations, provider contracting, customer service, financial analysis: Provider/payer strategy development or implementation; Provider/payer contracting and reimbursement, preferably managed care; delivery system administration, or equivalent combination of education and experience. Valid drivers license is required.



At Cambia, we are dedicated to making the health care experience simpler, better, and more affordable for people and their families. This family of over a dozen companies works together to make the health care system more economically sustainable and efficient. Cambias solutions empower over 80million Americans nationwide, including more than 3.4million people in the Pacific Northwest, who are enrolled in Cambias regional health plans.

Cambia is a total health solutions company that is deeply rooted in a 100-year legacy of transforming the industry and the way people experience health care. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future. Cambia is committed to delivering a seamless, personalized health care experience for the next 100 years.


This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit (link removed)/careers/total-rewards.


We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email (e-mail removed) Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.