Dignity Health Network and Provider Contracting Specialist in Bakersfield, California
The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Responsible for meeting all of the MCS Job Standards described below.
Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, , and Compliance.
Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
Routinely negotiates cost effective fees, confirms service capability, responds to provider inquiries, and educates providers on contract expectations, processes and paperwork. Supports implementation of strategies relating to the development and management of the provider network.
Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain a competitive position.
Bachelor’s Degree in healthcare administration or other related business field required; Master’s degree in Healthcare Administration preferred.
Three or more years working in a managed care setting, health plan, medical specialty group, hospital, other related healthcare setting.
Two or more years of contracting and negotiating experience involving complex delivery systems and organizations required.
Experience in managed care practices and procedures, specifically in contracting language and negotiations. Provider relations, self-insurance administration processes and/or claims processing experience is preferred.
Experience in developing and managing key provider relationships
Five or more years’ experience working in a high level administrative support position.
Combination of relevant education and work experience may be considered in meeting these requirements.
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Job ID 2018-66589
Employment Type Full Time
Department Business Solutions
Hours / Pay Period 80
Standard Hours Monday - Friday 8:00 AM - 5:00 PM
Work Schedule 8 Hour