Team Lead - Provider Contracting
At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.
This position will be responsible for providing best in class negotiating, contracting and provider operational leadership. This position will also direct Paramount’s day-to-day interactions with providers with respect to contracting. This position will lead a team comprised of one or more individuals. This position is responsible for developing and implementing operational relationships, quality controls, strategies and efficiencies/workflows to provide best in class contracting, analysis, and provider configuration.
This position may be assigned responsibility for other operational areas on an as needed basis, including but not limited to Provider Relations and provider analytics.
1. Facilitate and engage with providers and provider groups on contracting and other complex issues such as payment reform, quality and data sharing.
2. Create and implement project plans with timelines, milestones, and resources.
3. Analyze, design and implement work systems, transaction flow, reconciliation and quality assurance processes and methods related to contracting, provider analytics, and other assigned areas.
4. Work closely with internal departments and vendors to ensure timely and accurate data and information.
5. Manage contract boilerplates, keeping them updated and in compliance with regulatory requirements.
6. Work with legal team, Compliance, and other departments to implement and maintain provider contracts.
7. Provide written and verbal communication about contracts to providers and internal departments.
8. Network expansion activities in new and established coverage areas including identifying areas for potential expansion.
9. Directly supervise and manage one or more direct reports.
10. Assist Paramount Executive leadership with matters related to providers, plan sponsors, employers, regulatory agencies, and business development.
11. Work closely with Network Management and Health Care Services to establish and maintain policies, procedures, budgets, and standards related to contracting and provider relations.
12. Maintain and update department/team policies as appropriate.
13. Monitor, recommend, and implement improvements relating to staff, workflow, and processes.
14. Perform other duties as assigned.
- Education: Bachelor’s degree required.
- Sales, operations, project management, hospital system revenue cycle, health plan or payor experience.
- Demonstrated understanding of DRG, CPT/HCPCS coding, UB coding, ICD10 coding concepts, and medical benefit payment systems.
- Experience with financial analysis and modeling.
- Years of Experience: 3+ years experience negotiating provider or health plan contracts
- Education: Master’s degree preferred.
- Skills: Payor, provider, or governmental contracting, network management, value based, or business development experience. Experience with advanced data tools (Cognos, SQL, Truven, SAS, etc).
- Years of Experience: 1+ year supervisory experience
1. Proficiency with Microsoft Office tools.
2. Knowledge of claims payment methodologies, benefits and restrictions, and plan design.
3. Excellent presentation and oral and written communication skills.
4. Strong analytical and problem solving skills.
5. Excellent interpersonal, organizational and time management skills.
ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 49,000 employees, 12 hospitals, 2,500+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and 330+ assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visit www.promedica.org/aboutus.
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.
Equal Opportunity Employer/Drug-Free Workplace
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