[Hiring] Provider Contracting Executive @University of Utah Health

Role Description

This position for use in Health Plans Departments only. This position negotiates provider contracts, conducts reimbursement analysis, evaluates potential network providers, develops and maintains contracted physician fee schedules and provides assistance on ad hoc contracting projects. This position is not responsible for providing care to patients.

Responsibilities

• Plays a key role in establishing and maintaining strong effective relationships with providers serving as the liaison between UUHP and the provider organization, medical group and other healthcare providers.
• Negotiates low-volume, single-department, letter of agreements and invoice settlements with providers.
• Ensures all contracts are properly drafted and executed.
• Coordinates with multiple departments to ensure contract terms and provisions are effectively communicated and implemented.
• Serves as a resource to assist with escalated billing and policy issues.
• Conducts reimbursement analysis to determine financial impact.
• Conducts an analysis of potential network providers to assess potential business compatibility.
• Audits and troubleshoots negotiated reimbursement terms with claims and contract compliance systems.
• Maintains current knowledge of appropriate contractual provisions and of government regulations related to the establishment and maintenance of contractual arrangements.
• Represents provider relations and contracting department at meetings.

Qualifications

• Bachelor's degree in Business, Health Care Administration, Accounting, Nursing, or equivalency.
• Three years of health care industry or health insurance industry experience.

Preferred Qualifications

• Knowledge of ICD9 and CPT codes.

Requirements

• Ability to perform the essential functions of the job as outlined above.
• Strong oral and written communication skills to effectively communicate with a broad array of internal and external contacts.
• Proven ability to build and maintain positive relationships.
• Knowledge and understanding of the provider community and principles of healthcare delivery systems.
• Self-motivated with effective time management skills.
• Working knowledge of healthcare operations and billing principles.
• Good analytical and problem solving abilities.
• Experience using word processing, spreadsheet, database, internet and e-mail applications.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation. This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

• Listening
• Sitting
• Speaking
• Standing