Working Each Day to Make a Difference
At Community Health Plan of Washington, we're driven by our belief that everyone deserves access to quality health care.
More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.
We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.
We are a local not-for-profit health plan in Washington State.We are committed to keeping Washington families healthy.We connect our communities to the health resources they need.We provide access to high-quality care for our members.We connect and empower our members through technology.The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org{rel="nofollow"}.
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Provider Network Contract Administrator -- Hybrid, Seattle* *
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[POSITION PURPOSE:]{.underline}
The Contract Administrator is responsible for developing, maintaining, and expanding our provider network. This role will be actively engaged in negotiations with various provider types to ensure the continued delivery of high-quality healthcare services.
[PRINCIPAL DUTIES:]{.underline}
Negotiate hospital, physician groups, ancillary providers, and behavioral health agency contracts, and other provider types as needed.Initiate and maintain productive long-term relationships with provider networks and other agencies serving Community Health Plan of Washington (CHPW) enrollees.Perform contracting negotiation using reimbursement strategies that are aligned with CHPW objectives and meet the needs of the provider communities.Develops and uses effective cost and utilization reports for the administration of contracted relationships.Ensure provider negotiations and contracts are managed in a way that is complaint with various regulatory agencies, i.e., the Office of the Insurance Commissioner (OIC), Health Care Authority (HCA), and Centers for Medicaid and Medicare Services (CMS).Assures maintenance of accurate, current, detailed files with important provider information.Proactively identifies and addresses gaps in the provider network to improve member access and meet CHPW's network adequacy and regulatory requirements.Communicate proactively and effectively with internal and external business partners. Participates and reviews CHPW's policies and procedures that impact provider.relations and contracting.Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.[QUALIFICATIONS:]{.underline}
[Education &]{.underline} [Prior Related Experience]{.underline}:
Have a minimum of two (2) years of experience in contracting and/or contract management in Managed Care required.
Have a minimum of four (4) years of experience in contracting and servicing providers in an insurance setting, hospital, Behavioral Health environment, or other clinical settings, including working with physician groups, ancillary providers, and behavioral health agencies preferred.
Have familiarity with Washington St