Senior Contracting amp; Network Strategic Consultant

Scope of Department

The Provider Network Management department evaluates, initiates, and maintains the provider relationships for The OSU Health Plan faculty and staff provider network and external business provider networks, including but not limited to, Ohio PPO Connect.

The department manages activities related to system and provider contracting, network and provider information management, and credentialing.

Team members negotiate contract terms and ensure regulatory, business, and contract requirements are met. Responsibilities of the team include the development and support of statewide provider relationships,provider-relatedfinancial and quality analysis, network configurations, claim reimbursements, and other activities in support of provider networks.

The Provider Network Management Department is responsible for greater than $300 million in medical spend through the universitys third party administrator.

The team serves approximately 150,000 lives as well as partners with external lines of business to implement customized provider networks that optimize access, cost, and quality.

Scope of Position

This position serves as the Senior Contracting amp; Network Strategic Consultant on the health plan provider relations team.

The Senior Contracting amp; Network Strategic Consultant reports to the Director of Provider Network Management and works collaboratively with clients, third party administrators, directors, managers, clinicians, and other provider network management team members to optimize access, cost, and quality within our provider networks.

The Senior Contracting amp; Network Strategic Consultant collaborates with the Director of Provider Network Management and the Manager of Provider Network Management to create, execute, and evaluate high level network and contracting strategies.

Position Summary :

The Senior Contracting amp; Network Strategic Consultant fosters relationships with key contacts at critical professional, facility, and ancillary service providers and leads highly complex contract negotiations for professional, facility, and ancillary service providers.

The senior consultant leverages the senior financial analysts in the evaluation of the financial and quality performance of contracted providers and proposes innovative, financially beneficial, and value-based reimbursement models for strategic providers.

The senior consultant tracks, trends, and makes recommendation on network adequacy and ensures the health plans compliance with any professional, facility, or ancillary service provider contract exceptions.

The Senior Contracting amp; Network Strategic Consultant represents the Provider Network Management department in its strategic network partnerships, including participating in the Ohio PPO Connect Executive Committee and the High Performance Health Network Steering Committee.

The senior consultant collaborates with the Business Development Director on new and renewal business pricing proposals and facilitates responses to all provider network management RFPs.

The senior consultant completes external business budgets and administers projects related to providers, networks, reimbursement methodologies, contract documentation, and provider communications.

The Senior Contracting amp; Network Strategic Consultant oversees the development and maintenance of all provider contract templates, including but not limited to, contract body, fee schedule and network attachments, and any special provisions and collaborates with external legal counsel on an as needed basis to modify contract templates to ensure compliance with regulatory requirements.

The senior consultant sets the agenda for the Network Strategy workgroup and educates the Provider Network Management Specialists on best practices for effective and efficient payment methodologies, contract preparation, and negotiation.

Minimum Qualifications

For Hire : Bachelors Level Degree or equivalent education and experience required. Masters degree preferred. Minimum of 8 years of experience in contracting / network development with significant autonomous and diverse experience in professional, facility, and ancillary service contracting.

Extensive independent knowledge of provider reimbursement methodologies required, including but not limited to, value-based, bundled payment, capitation, percent of Medicare, percent of billed charges, and case rates / per diem strategies.

Extensive knowledge of provider network management desired (network design, products, customer service, provider communities).

Full comprehension of health care issues to effectively collaborate with health plan, provider organization, and facility practice personnel required.

Demonstrated superior critical thinking, negotiation and analytical skills required. Ability to work effectively with deadlines.

Ability to cope with frequent interruptions and to prioritize projects. Ability to be organized and methodical in coordinating provider contracting activities with various departments within OSUHP as well as external entities.

Strong collaboration and communication skills are a requirement. Experience in health plan or health insurance preferred.

Ongoing : Maintains knowledge of The Ohio State University Health Plans policies and procedures and functions within those guidelines;

maintains positive member and colleague relations.