Provider Contracting Executive Senior

Overview

Hybrid opportunities in Renton, Burlington, Spokane or Tacoma, Washington.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For

Every day, Cambia’s dedicated team of Provider Contracting Executives are living our mission to make health care easier and lives better. As a member of the Provider Contracting team, our Provider Contracting Executive Senior leads the development and management of strategic contracting relationships with top-tier physicians, groups, institutions, and ancillary providers. Drive business growth through innovative products and reimbursement methodologies, while cultivating and maintaining key relationships and overseeing complex contract negotiations and administration – all in service creating a person-focused health care experience.

Do you have a passion for serving others and driving business growth? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

• The Provider Contracting Executive Senior would have a Bachelor’s Degree in healthcare, business or a related field and 7 years’ experience in a healthcare industry provider contracting, relations or analytical capacity or equivalent combination of education and experience.

Skills And Attributes

• Strong industry knowledge:
  Strong understanding of managed care and accountable health system models, and their relationship to contracting strategy and reimbursement methodology.
• Negotiation and relationship-building skills:
  Proven ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
• Payment methodology expertise:
  Demonstrated competency in varying payment methodologies, including Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, and Per Case.
• Strong understanding of value-based programs and contracting models.
• Proficiency and comfort in negotiating complex contract language.
• Data analysis and strategy development:
  Ability to analyze financial, quality, and utilization data to develop contracting strategies and manage a portfolio of contracts.
• High-pressure environment skills:
  Ability to work effectively in high-pressure circumstances, managing conflict and ambiguity.
• Senior-level negotiation and communication skills:
  Proficiency in building relationships and negotiating successfully with large, complex, and market-leading institutional and professional providers, and ability to independently and effectively communicate with high-level executives internally and externally.
• Leadership and portfolio management:
  Ability to oversee and manage a portfolio of contracts and provide leadership and guidance to others in the organization.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

• Maintains and expands the health care delivery system network by negotiating contracts and maintaining relationships with providers, positioning the organization to meet its objectives relating to cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning, and profitability.
• Monitors financial and utilization performance of contracts, develops plans to improve performance, and meets with key provider leaders to review reports, prepare analysis, and recommend strategies.
• Develops and maintains new regional networks to support the introduction of new products, understanding health plan market pricing and communicating strategic benefits to providers.
• Collaborates with provider consultants and representatives to ensure contracts are administered appropriately and improvement plans are managed.
• Develops and manages risk arrangements, including pricing and accountable health system funding arrangements, and leads plan initiatives/pilots focused on provider network configuration, reimbursement, and management.
• Develop long and short-range contracting strategies for each delivery system assigned, with a focus on reducing healthcare expenditures…