Kettering Health Network

  • Payer / Provider Engagement Consultant- Admin Support Building- Full-Time

    Posted Date 2 months ago(4/16/2019 2:14 PM)
    Job ID
    2019-15420
    Job Category
    Administrative/Business Support
    Job Type
    Full-Time
    Shift
    First Shift
    # of Openings
    1
    Shift Time
    Days
    FTE
    80 Hours Per Pay Period/FTE 1.0
  • Overview

    The Payer / Provider Engagement Consultant acts as a liaison between Kettering Health Network (KHN) and Kettering Physician Partners (KPN) as well as supports KHN’s Clinically Integrated Network (KPP).  The Payer / Provider Engagement Consultant is primarily responsible for establishing, building and maintaining positive relationships with the providers (individual and group practices), independent physician’s associations, multi-specialty groups, affiliated health centers, and clinically integrated health care service entities, Payer organizations, Third Party Associations (TPA), Brokers or Employers, relative to value based and risk-based payer engagement agreements and alternative payment models along with traditional fee-for-service agreements. This position reports to KHN’s Director of Managed Care.

    Responsibilities & Requirements

    KEY JOB RESPONSIBILITIES:

    • Acts as the primary liaison between the provider community, payer organizations and KHN.
    • Establishes, builds, and maintains positive working relationships with the providers and payers, their staff through conducting regular contact with and visits to provider sites along with setting up payer Joint Operating Committees (JOC) meetings. Visits may include presentations, staff educations, provider orientations, Payer Value-Based Agreements (VBC), VBC operations unique to payers, monitors provider and payer program success.
    • Develops VBC provider education material, training programs, schedule and collaborate with providers and payers relative to KHN, KPN and KPP. Oversees contract relation, logistics related to value-based relationships with providers and payers.
    • Creates operational and financial dashboards, scorecards and profiles and other operational and financial tools for successful administration of VBC or fee-for-services contracting.
    • Keeps a pulse on provider and payer relation concerns and ensures all provider and payer issues are promptly reviewed and resolved and or/refers them to appropriate person continuing to track follow up to resolution.
    • Responsible for communicating and educating providers on value-based contracts and engagement relationships with payers, TPAs, employers and payers. Provide information, resources and tools to providers on how to be successful in such relationships including best practices and collaboration on engagement relationships between practices, payers and the CIN.
    • Effectively and professionally represents KHN, KPN and CIN with payers, providers and provider organizations.
    • In collaboration with the KHN Director of Managed Care, Manager of Contract Compliance works to identify and resolve issues between the payers, TPAs, providers, employers and CIN.
    • Develop system to collect financial, operational, clinical and administrative issues that are occurring between the practices and payers, facilitating resolution of such issues.
    • Keeps internal team, including credentialing, patient accounts, contract compliance and Director of Managed Care informed about identified payer, TPA, employer and provider interactions, issues and meets routinely with that KHN, KPN and KPP, sharing information and insights.
    • Ensures policies are developed as appropriate for areas of responsibility and that the processes are developed and maintained to adhere to these policies.

     

     

    REQUIREMENTS:

     

    Education: Bachelor’s degree in healthcare or related field, required.  Masters in healthcare, preferred.

     

    Experience:

    • 5-10 years of healthcare background, specifically in the areas of physician practice management, business development, payer/provider relations are key.
    • Requires strong relationship building skills with physicians, office staff, payers and members of the healthcare network.
    • Must have a firm understanding of managed care contract terms, including value and risk-based contract terms and concepts and be able to effectively gather, analyze, communicate and educate providers, KHN leaders, and payers on all aspects of agreements.
    • Must be able to work independently in both an organizational start up mode as well as growth and maintenance mode.
    • Must be highly organized and able to manage multiple projects, dashboards, and multiple high-level priorities.
    • Communicates clearly and effectively in written and verbal conversations.
    • Works under short deadlines, is flexible, open to change based on leadership dialog.
    • Knowledge of the managed care/value-based healthcare industry preferred.
    • Demonstrated ability to manage projects from conception through implementation.
    • Must be able to travel within our KHN geographic territory and beyond with some travel for educational purposes.

     

    Licensure, Certifications, Registrations:

    Physician Practice management, client relations, process improvement or industry relative certification 

     

    Work Environment:

     

    • Office setting to include, provider offices and healthcare organizations.
    • Require early morning and late-night meetings based on payer or provider needs.
    • Pleasant office environment, with computer, phone, and printers to ensure the tools and resources necessary to provide great provider relations services.

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