Provider Network Specialist
Summary
Acts as the lead liaison between physicians, payors, and Physicians of Southwest Washington's Clinically Integrated Network: negotiates provider agreements, builds fee schedules, resolves provider issues, and coaches practices on performance improvement. Requires 5 years of healthcare administration experience; position must be based in Spokane, WA.
** Position must reside in Spokane, WA **
Summary / Objective:
The Provider Network Specialist is a highly strategic role within PSW, designed to act as lead liaison between providers, payors, and PSW including investigating and resolving provider operations issues. The Provider Network Specialist will perform training, orientation and coaching for performance improvement within physician practices, ultimately providing value to the physician and office through expertise, consultation, and change management. This position is the relationship manager for the practice, existing to help streamline the physician experience with PSW, while working to identify and address improvement opportunities. Responsible for establishing and cultivating relationships with key area providers and key constituents for the purpose of joining and contributing to the overall performance of PSW’s Clinically Integrated Network (CIN) portfolio.
Essential Functions:
• Provides subject matter expertise, consultation and education to PSW physician members by establishing and maintaining a strong relationship with the physician and practice.
• Negotiates Participating Provider Agreements with physician members of PSW.
• Creates reimbursement fee schedules (e.g. Medicare Advantage, Commercial, and others)
• Provides education on a wide variety of topics (e.g. population health, clinical integration, & access strategies)
• Receive and respond to external provider related issues.
• Reports barriers and problems that affect the ability of the CINs to achieve its quality, service, and cost targets to PSW leadership and is responsible for ensuring remediation and resolution.
• Maintains contact and develops rapport with others in provider practices such as practice administration roles to ensure operational alignment of those practices by achieving the CINs quality, service, and cost targets.
• Familiarity with gain sharing or risk sharing contract language.
• Builds provider engagement through routine office visits, telephone contacts, and prompt attention to provider needs and concerns. Acts as main point of contact.
Knowledge, Skills & Abilities:
• Set a positive example by displaying a pleasant and approachable demeanor.
• Proactive team player, strong follow-through, quick decision-making abilities and abilities to problem solve.
• Interpersonal skills, with the ability to build strong relationships at all levels.
• Strong verbal and written communication skills with customers, supervisors, and co-workers.
• Strong organizational, time management and prioritization skills:
• Self-starter. Ability to set priorities and keep to projected schedules.
• Excellent computer proficiency (MS Office – Word, Excel, and Outlook) including being able to effectively maintain written and computer records in accordance with regulatory agencies.
• Ability to work effectively and collaboratively with senior levels of management; physicians, physician groups, and physician practice administration
• Ability to flex schedule to meet with individuals in early morning, evenings, weekends, and as needed to enhance relationship building efforts.
• Ability to work with conflict and ambiguity.
Required Education and/or Work Experience:
• Bachelor’s degree in healthcare administration, business administration, or comparable.
• 5 years of experience in the healthcare administration industry; 10 years of relevant healthcare experience may be considered in lieu of a completed degree.
• Strong interpersonal and communication skills, with the ability to build and maintain professional relationships.
• Proficiency in Microsoft Office Suite, CRM platforms, and event management tools.
• Detail-oriented with strong organizational and multitasking abilities.
• Ability to work independently and collaboratively in a fast-paced environment.
Preferred Education and/or Work Experience:
• Experience in value-based contracting.
• Experience in an Accountable Care Organization (ACO), Managed Care, or healthcare provider network setting.
• Knowledge of healthcare regulations, provider credentialing, and payer-provider relationships.
Required Certificates, Licenses and Registrations:
• Valid driver’s license.
*PSW does not typically hire at the top of the pay range *