Northwest Permanente, P.C. is a self-governed (physician led), multi-specialty group of over 1500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's pre-eminent health care systems, a benchmark for comprehensive, integrated and high quality care.
This position plays an integral role in the Provider Contracting & Relations Department in managing the contract document development process, including production, quality control, execution, signature approval tracking and final retention of documents. This is a critical function to ensure provider contracts produced in the Northwest Region uphold Kaiser Permanente’s fiscal, regulatory, legal, business and reputational needs. In partnership with the Contract Compliance Manager and Provider Contract Managers, this position ensures contract compliance with applicable state and federal regulations and standards, as well as legal, regulatory and accreditation requirements.
This position initiates all credentialing and privileging requirements with external contracted physician and facility providers and works in conjunction with the Regional Quality Resource Management Department to ensure credentialing/delegation and recredentialing are completed prior to execution of contracts. Position advocates for delegated credentialing, wherever feasible, to lessen the administrative burden to KPNW and hospital and medical group providers in the credentialing process. Provider’s successful completion of credentialing prior to the execution of the contract is necessary to warrant provider’s compliance with state, federal, accrediting and NCQA requirements, and is critical to ensuring patient safety, and to mitigate any potential risk to KFHP-NW, KFH, and NWP.
The Contract Coordinator is responsible for the effective and accurate administration of all contract and provider demographics for the NW Region. He/she is responsible for ensuring integrity of provider demographics, and is accountable for securing, managing, and maintaining all external physician and facility provider demographics which feed critical downstream patient care, financial and referral systems, including EPIC/HealthConnect, Pharmacy, Credentialing, Referrals, Provider System of Record (PSR), provider directories including KP.org, and Tapestry/Claims. The NW Region is required to demonstrate to regulators (e.g., CMS, OIC, and the Oregon Insurance Division) an adequate network of providers that are compliant with regulatory and other oversight and accreditation agency standards. The provider demographics managed by this function is foundational to the development, maintenance and reporting required of KPNW to demonstrate its network adequacy.
Additionally the Contract Coordinator is responsible for researching and collating information regarding individual primary and specialty care providers, provider groups, ancillary, skilled nursing, home health, ASC’s and hospital facilities available in designated geographic areas, in an effort to assist KPNW Contracting, Operations and Care Delivery teams in identifying services and providers potentially to be targeted for contracting, in order to meet Care Delivery and Network Adequacy requirements in geo expansion areas (e.g., Lane County).
Works independently, and with Contract Managers and department leaders to create contract documents which are developed in conjunction 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 State of Washington Office of the Insurance Commissioner (OIC), collaborates with the Provider Contract Managers, Director Provider Contracting, or Senior Director to draft and refine compensation exhibits and other contract language provisions. Works closely with the Contract Compliance Manager, Regional Contract Managers, and National Provider Contract Managers and staff to insure timely filing of contracts with the Washington OIC.
Builds and maintains effective partnerships with network and affiliated practitioners, provider groups, hospital and facility organizations in order to research, collect and maintain key demographic information related to contracts, provider entities, practitioners and locations in the appropriate systems. The accuracy and availability of this data is critical in ensuring functionality and credibility of multiple downstream systems (Claims, Pharmacy, Credentialing, HealthConnect, Referrals, Provider System of Record, KP.org). May assign and train other staff (e.g., temp or permanent provider data specialists, department admin.) in the development and maintenance of provider demographics. In addition, the position works closely with the Regional Quality Resource Management Department to initiate the credentialing and privileging process for external contracted medical facilities, physicians, practitioners and other medical professionals to ensure that all credentialing and organizational assessment requirements are met prior to execution of provider contracts. The data integrity and credentialing is critical to ensuring patient safety and that the needs and standards of finance, regulatory, provider directories, network adequacy and other business interests are met.
Researches claims issues including provider not found and provider demographics. Provides timely and accurate resolution to key constituents to insure claims are processed in an expedient manner once a claims issue is identified. Communicates with provider, claims and provider relations personnel and Business Analyst to resolve pending claims. Determines whether claims received are contracted or non-contracted based on medical services rendered and billed, contractual relationship between rendering and billing provider, scope of contracted services, and configuration detail.
Manages a variety of priority contracting project responsibilities, as assigned by the Sr. Director or Director, Provider Contracting, Mgr., Contract Compliance and Operations, and/or his/her designee. Examples include researching and evaluating potential providers available to meet Care Delivery requirements in market expansion areas, (e.g., KP’s network expansion in Lane County), developing provider reimbursement/statistical reports from Cognos, or specialized reporting for purposes of informing leadership of high priority project status. Designs and develops specialized reporting tools related to contract operations and for use by management in the oversight of network development activities.
Communicates with outside providers and facilitates resolution of issues in order to preserve a positive relationship with community providers while insuring a positive KP member experience for services provided by community providers (professional, hospital and ancillary services). Appropriately confers, collaborates with and escalates complex issues to appropriate staff persons within Provider Contracting and Relations or outside departments.
Collaborates with Contract Compliance Manager, Director and Sr. Director, Provider Contracting and Relations in managing compliance and other departmental projects and initiatives including, but not limited to, facilitation of internal audits, state and federal audits and assessments (e.g., CMS, Washington OIC, NCQA), corrective action plans, regulatory bulk amendments, development of reporting and tracking related to contract compliance initiatives, and network adequacy.
Minimum Education Requirement:
Minimum Work Experience:
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.