Provider Partnership Strategist

Join PacificSource and help our members access quality, affordable care!

• →Manage for ongoing or to completion: initiatives, activities and projects resulting from partner and PacificSource identified opportunities, with engagement across all lines of business.
• →Provide ongoing training, coaching and high-touch support to network system providers and staff toward the development and implementation of improvement activities to support process improvement from PacificSource and external partner.
• →Collaborate with multiple departments to develop and deploy aligned initiatives, process improvement activities, and enhance workflows to improve provider partner satisfaction and streamline processes for better member care outcomes and service.
• →Track project progress and communicate to JOC participants and other stakeholders; develop and manage JOC schedule; timelines, activities, and milestones.
• →Provide direct provider support through contracting auditing, working as a liaison with internal departments to support improved processes with claims processing, facilities, group and provider set up.
• →Provide education to applicable Providers on PacificSource products, administrative procedures, legislative, and compliance requirements.
• →Work directly with Provider Network and other departmental leadership to advance JOC initiatives, working closely with other work stream leaders including Contracting, Health Services, Pharmacy, Analytics, IT, Population Health and Risk Adjustment.
• →Work with internal stakeholders and business owners to present and review data and deliver provider reporting packages. Assist in identifying opportunities/trends, tools, and proposed course of action to help meet incentive, quality, and operational goals as appropriate.
• →Work with consultants and various areas of hospital(s) - finance, clinic managers, billing supervisory staff, Utilization, Credentialing -to develop a strategic direction based off of current processes and opportunities. Create and help execute a collaborative roadmap to accomplish established goals.
• →Prepare materials and presentations for meetings, with the assistance of the Provider Relations Representative, Quality Coordinator, and other applicable personnel. Conduct/participate in group operational meetings.
• →Receive, analyze, and respond to provider issues and assure timely, appropriate follow-up. Work to identify potential trend issues and seek resolution(s).
• →Serve as a provider contact and problem solver for a wide range of issues including, but not limited to; claims, operational, encounter, quality, risk provider, clinic, billing, health services notifications, capitation/financial, contractual details and any data/reporting needs.

• →Understand contracting methodologies and terms for all lines of business.
• →Proactively develop positive working relationships with other PacificSource departments and staff to resolve provider issues.
• →Develop thorough knowledge of system capabilities related to Facets setup, Facets Business Support, other supporting systems.
• →Exercise independent judgment and communicate effectively between internal and external team members.
• →Meet department and company performance and attendance expectations.
• →Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• →Maintain clear understanding of system set-up and reporting requirements/limitations as required by contractual obligations.
• →Participate in provider specific and public presentations as required.
• →Assist in leading, shaping and developing special projects related to PacificSource initiatives.
• →Perform other duties as assigned.

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.

• We are one team working toward a common goal.

• We are each responsible for customer service.

• We practice open communication at all levels of the company to foster individual, team and company growth.

• We actively participate in efforts to improve our many communities-internally and externally.

• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.