Responsible for leading/project managing strategic internal resources required to address assigned provider business partnerships and relationship issues. Once a new relationship with a provider is forged through the negotiation and contracting process, the Strategic Coordinator is a key liaison for all quality and unique aspects of the relationship between CDPHP and the provider. He/she is responsible for successfully administering, servicing, monitoring and growing strategic relationships with assigned providers across all lines of business. Additionally, the Strategic Coordinator will be responsible for the coordination of all internal provider-focused strategic initiatives of the Medical Affairs, Network Strategy, Marketing/Sales, Strategic Engagement and any other related departments within CDPHP. The Strategic Coordinator will manage such contract, educational, and administrative interactions regarding key quality and reimbursement initiatives with the provider network and will identify and track all high importance and/or re-occurring issues relating to operational, educational, clinical, and other administrative business issues.
- High school diploma or GED required. Associates degree preferred.
- Minimum of 7 years direct provider business-to-business relationship management experience in health care administration preferred.
- Experience in hospital, ancillary and physician claims payment and other system pricing details required.
- Experience working with clinical personnel in supporting clinical initiatives in quality metrics (HEDIS, QARR, NCQA, etc), health care coding, state and federal regulations and reimbursement methodologies required.
- Experience with business analysis, risk mitigation, relationship management and new business process enterprise implementation with data metrics collection and reporting preferred.
- Working knowledge of provider reimbursement and payment methodologies is required.
- Comprehensive understanding of Commercial, Medicare and Medicaid reimbursement methodologies and rates required.
- Must possess thorough knowledge of contracting structures and payment methodologies.
- Must be able to effectively coordinate across, up, and down the organization to resolve provider issues and implement strategic initiatives.
- Must have strong analytical skills and be an excellent strategic thinker.
- Strong detailed managed care product knowledge across all CDPHP lines of business.
- Demonstrated ability to successfully and positively interact with external provider senior financial and operations management, physicians and business offices.
- Robust analytical skill in database management through experience with Excel and/or Access databases.
- Proficiency in Microsoft Word, Excel, PowerPoint and Access.
- Ability to adapt to regional travel.
Salary Grade: 15
CDPHP - 18 months ago