Northwest Permanente, P.C., is a self-governed, physician-led, multispecialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, and high-quality care.
The Contract Administrator (CA) is responsible for supporting all aspects of contract development and compliance, including contract language, preparation and submission of contract documents to WA State Office of the Insurance Commissioner (WA OIC), and importing of regulatorily approved contract templates and implementation of negotiated agreements in department's contract management (CM) system. The CA contributes to optimization of contracting processes that intersect with CM system. The CA is accountable to compile, develop and maintain an alternative contract language library in conjunction with legal and department leadership. The CA performs quality and continuous monitoring to ensure contractual documents produced and stored in CM system are in accordance with established SLAs, department policy, legal and regulatory requirements, guidelines, and standards.
Under direction of leadership, CA is accountable for filing all appropriate contract templates and agreements with the WA OIC and daily monitoring of regulatory response to filings.
Analyze contractual documents and complete analyst checklists and standards to ensure state and federal regulatory requirements are met.
Collaborate with team members to respond to regulator objections and comments.
Prepare contract documents for filing ensuring finished contracts reflect Kaiser Permanente's business, legal, regulatory, and reputational interests, including the following:
Creating compliant filings for submission to the WA OIC's SERFF system,
Develop filing description to include summary of major contract changes and analyst checklist to accompany filings, anticipating issues and positively influencing state regulator review,
Monitor and record status of active filings through to approval/disposition, updating Provider Contracting staff, Legal and/or Regulatory departments with timely notice of any responses or action required to obtain approval of the filing,
Coordinate with regional and national provider contracting staff, Legal, Regulatory and Compliance departments to develop KP's response to active suspension comments from the regulator. Engage and coordinate input from appropriate subject matter experts to achieve timely and strategically appropriate responses.
Manage retention of pertinent filing documents, history and disposition for each filing.
Utilize training and other materials provided by Program Office Legal, NWP General Counsel and own expertise to develop legal resource guide for Provider Contract Manager's use.
Develop and maintain compilation of approved alternative language library and standard compensation exhibit templates.
Provide expertise to assist in developing proposed language alternatives while mitigating risk to KP and upholding KP business interests.
Review and/or draft contract documents, amendments, language provisions or compensation exhibit at the direction of department leadership. Documents are to be developed or reviewed in compliance with departmental policy, agreed upon financial provisions, care delivery requirements, and legal, regulatory, accreditation and compliance standards.
Ensures departmental contract processes are followed, contracts are developed in accordance with strict guidelines, and final approvals are secured prior to execution, including identifying contracts which require filing with the WA OIC.
Supports a variety of priority contract compliance responsibilities, as assigned, including:
Facilitation of internal audits and state and federal audits/assessments (e.g., CMS, Washington OIC),
Corrective action plans,
Regulatory contract amendments,
Development of reporting and tracking data as it pertains to contract compliance initiatives.
Partners with Provider Contracting Department leadership, Program Office Sr. Counsel, NWP Senior Counsel, Regional Regulatory and Compliance departments and under direction of Mgr., Contract Compliance, to ensure contract templates used in the department are comprehensive, up to date and comply with the most current state and federal regulations, and make available to staff for use in department's Contract Management (CM) system.
Assist in creation and maintenance of custom forms to support the various contract templates that need to be implemented and managed by dept.
Assist with testing and validation of new contract templates in the CM testing environment prior to the release in CM production and participates in CM testing cycles for new system upgrades or enhancements as it pertains to the Library Manager functions.
Provide back-up support to the dept. BA for permissioning in CM system.
Departmental Support and Training
As directed, prepare, and distribute reports and statistical data to facilitate planning and maintenance of accurate contract records and files.
Works collaboratively with Provider Contracting staff to implement, monitor, and facilitate efficient contracting efforts and processes, and to ensure provider contracts meet regulatory, business, and reputational interests.
Responsible for monitoring, managing, analyzing, and auditing contractual agreements, and their associated workflows, within department's contract management ("CM") system, and for creating reporting of department's contractual agreements to ensure integrity and completeness of contract lifecycle, metadata and reportable information memorialized within CM and to raise awareness to dept. leadership and staff for any noted defects or areas of improvement.
Identify and recommend suggested enhancements regarding CM process and CM system to potentially expand and strengthen its use and functionality.
Support training users on the process, procedures, and database functions to ensure efficient and effective production of work product.
Bachelor's degree in business, legal, health care administration or equivalent experience.
Minimum Work Experience:
Minimum five (5) years experience in managed care contracting, legal administration or paralegal, health plan administration, or other comparable experience providing incumbent the skills necessary for the position.
Proficient use of PC software applications.
Must possess excellent written and verbal communication, presentation and listening skills.
Experience with contract language drafting, preparation, and analysis; strong familiarity with managed care contracting principles. Language review and editing to include ability to identify and correct errors in English usage, grammar and contract defined terms.
Excellent interpersonal and relationship building skills; ability to build rapport and a culture of mutual respect to deal effectively with individuals at all levels of responsibility and authority.
Team player demonstrating a positive attitude, strong work ethic, curiosity, and humility.
Must demonstrate adaptability and high tolerance/proven success to function within a complex, sometimes ambiguous, demanding, and dynamic work environment.
Excellent project management skills. Master multi-tasker; ability to work effectively under pressure, multi-task and organize workflow to deliver high quality work product on multiple competing priorities within constrained timelines.
Strong critical thinking, discernment, independent problem solving and decision-making ability.
Ability to exercise a high degree of discretion and confidentiality in dealing with sensitive information to which position has direct knowledge.
Ability to interpret and apply legal concepts, contractual and regulatory requirements, and standards.
Ability to work with a diverse group of individuals both internally and externally, including legal and regulatory representatives, physicians, management, and executive leadership; ability to develop strong relationships and use tact, diplomacy, and influence to achieve desired outcomes.
Position requires a highly self-motivated individual who can prioritize assignments and work both independently and as a team member in achieving objectives.
Strong organizational skills, strict attention to detail, and demonstrated commitment to exceptional work product.
Strong analytical skills and ability to present information in an understandable format.
Ability to synthesize a variety of data to produce a cohesive and well-documented process.
Bachelor's degree in business, legal or health care administration.
Preferred Experience and Qualifications:
Minimum eight (8) years experience in managed care contracting, legal administration or paralegal, health plan administration, or other comparable experience providing incumbent the skills necessary for the position.
Advanced knowledge of applicable federal and state laws and regulations related to healthcare (those pertaining to managed care contracting, network adequacy, NCQA, Medicare, Medicaid, Washington Office of the Insurance Commissioner).
Significant experience in the review and drafting of contract language, health plan operations (referrals, prior-authorization, product design) highly preferred.
Ability to work within and to support a team environment, yet work independently completing multiple tasks with minimal supervision. Requires a high level of initiative, sound judgment and the ability to work under pressure in a constantly changing environment, balancing multiple competing priorities.
High level of computer competency in various software applications such as Microsoft Office Suite (Word, Power Point, Excel), legal and contract management software.
Knowledge of health care delivery systems and operations, specific knowledge of Kaiser Permanente medical care delivery operations and systems highly desired.
At Northwest Permanente, P.C., we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente, P.C. believes that diversity, inclusion, and equity among our employees is critical to our success and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.
Physician Opportunities in Oregon & Southwest Washington. For more information please visit https://nwpermanente.com/jobs/About Us - Northwest Permanente is the Northwest’s largest physician-led, self-governed multispecialty group. We have opportunities available across the region in Portland, Salem, Oregon, and Longview, Washington. Northwest Permanente physicians practice medicine with a purpose that provides unparalleled opportunities for a meaningful and rewarding career in medicine.