Provider Contracting Executive

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

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.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Responsibilities

Essential Functions

• 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.

Knowledge / Skills / Abilities

• 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.

Qualifications

Required

• Bachelor's degree in Business, Health Care Administration, Accounting, Nursing, or equivalency.

• Three years of health care industry or health insurance industry experience.

Qualifications (Preferred)

Preferred

• Knowledge of ICD9 and CPT codes.

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

Multi-lingual Candidates Welcomed

To inquire about this posting, email: View email address on click.appcast.io

EEO Statement

University of Utah Health Hospitals and Clinics, a part of The University of Utah, values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patient populations.

All qualified individuals are encouraged to apply. Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities.

University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Affirmative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran's status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both.

To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at View phone number on click.appcast.io. If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity (OEO). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at:

Online reports may be submitted atoeo.utah.edu/

The University is a participating employer with Utah Retirement Systems (“URS”). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work). Contact Hospitals and Clinics Human Resources at View phone number on click.appcast.io for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS’ post-retirement rules and restrictions. Please contact Utah Retirement Systems at View phone number on click.appcast.io or View phone number on click.appcast.io or Hospitals and Clinics Human Resources at View phone number on click.appcast.io if you have questions regarding the post-retirement rules.

This position may require the successful completion of a criminal background check and/or drug screen.

Requisition Number 84676
Reg/Temp Regular
Employment Type Full-Time
Shift Day
Work Schedule M, T, W, Th, F (8-5)
Location Name University of Utah Health Plans
Workplace Set Up Remote
City Murray
State UT
Department UIP CST 01H UUHP PROVIDER SRVC
Category Health Plans
Workplace Set Up Remote