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Contracts Administrator, Seattle, WA


Community Health Plan of Washington

Administrator

Seattle, WA

November 20, 2019


Working Each Day to Make a Difference

At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

  • We are a local not-for-profit health plan in Washington State.
  • We are committed to keeping Washington families healthy.
  • We connect our communities to the health resources they need.
  • We provide access to high-quality care for our members.
  • We connect and empower our members through technology.
  • The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.

Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system. To learn more about how you can make a difference working at Community Health Plan of Washington, visit www.chpw.org.

Contracts Administrator

POSITION PURPOSE:

Accountable for developing, maintaining, and expanding the provider network and, conducting negotiations with various provider types.

PRINCIPAL DUTIES:

Contract Negotiations

  • Negotiates hospital, physician groups, ancillary provider, behavioral health, Long Term Support Services contracts, as well as, Care Coordination Organizations, Area Agencies on Aging serving Health Home initiatives in Washington State and other provider types as needed.
  • Performs contracting negotiation using reimbursement strategies that are aligned with Community Health Plan of Washington objectives and meet the needs of the provider communities.
  • Ensures provider negotiations and contracts are managed in a way that is in compliance with various regulatory agencies, i.e., OIC, HCA, and CMS.
  • Assures maintenance of accurate, current, detailed files with important provider information.
  • Proactively identifies and addresses gaps in the provider network to improve patient access and meet Community Health Plan of Washington’s network adequacy requirements.
  • Prepares and distributes necessary documents to complete the contracting process to operationalize contracts. Maintain and Improve Contracted Provider Relationships
  • Initiates and maintains productive long-term relationships with the provider networks allied systems, and other agencies such as mental health and substance use disorder agencies.
  • Communicates proactively with other departments to ensure effective and efficient business results.
  • Develops and uses effective cost and utilization reports for the administration of the contracted relationship.
  • Leads teams of Community Health Plan of Washington subject matter experts to resolve provider specific and systemic operational issues.
  • Participates and reviews Community Health Plan of Washington’s policies and procedures that impact provider relations and contracting.
  • Responds effectively to HCA and OIC complaints submitted by providers.
  • This position involves traveling on behalf of the Company. It is essential that a current driver’s license, an acceptable driving record, and proof of automobile are maintained.

Other Functions:

  • Other duties as assigned.

QUALIFICATIONS:

Education:

  • Bachelor’s degree (in Business Administration, Finance, or related field) or a combination of education and highly relevant experience required.

Prior Related Experience:

  • Minimum 2 years of contracting and/or contract management in Managed Care required.
  • Minimum 4 years contracting and servicing providers in an insurance setting, hospital, Behavioral Health environment, or other clinical settings preferred.
  • Knowledge and Experience with Health Homes in Washington State
  • Experience with risk arrangement and, value-based purchasing

Employment Eligibility:

  • Candidate 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.

Knowledge, Skills, and Abilities:

  • Requires knowledge and experience in contract negotiations with various reimbursement methodologies such as fee for service and capitation.
  • Must be able to maintain current contracting strategies in a managed care setting.
  • Maintains knowledge of state and federal regulatory requirements as it relates to provider contracting.
  • Ability to meet scheduled deadlines with minimal supervision.
  • Strong organizational skills and accurate work results.
  • Proven track record of maintaining a professional appearance, demeanor and confidentiality.
  • Excellent public speaking, written communication and problem-solving skills.
  • Ability to understand and communicate various services and products of Community Health Plan of Washington.
  • Strong analytical and negotiation skills.
  • Ability to work in a team environment.

To apply, please visit: www.chpw.org/careers

We're committed to our employees and their family, which is why we offer benefits that, makes a difference in their lives. Paid time off, tuition reimbursement, community service hours, and transportation perks are just a few of the offerings of our comprehensive and competitive benefits program.

Community Health Plan of Washington is an Equal Opportunity Employer with a diverse workforce!

Headquarters: 1111 3rd Avenue, Suite 400 Seattle, WA 98101


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