As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position for use in Health Plans Departments only. This position is responsible for the development of payer and provider contractual and business relationships on behalf of University of Utah Health Plans. This position negotiates complex contracts for facilities and large physician practices, conducts detailed reimbursement analysis, evaluates potential network providers and oversees ad hoc contracting projects.This position is not responsible for providing care to patients.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Essential Functions

• Plays a key role in establishing and maintaining strong, effective relationships with providers serving as the liaison between UUHP and the provider organization, medical group and other healthcare providers.
• Negotiates complex facility and provider agreements involving multiple payment methodologies and ACO concepts. Analyzes various managed care and ACO reimbursement methodologies, conducts reimbursement and market analysis to recommend reimbursement rates and methodologies and to determine financial impact to the organization.
• Resolves contractual and reimbursement issues, and operational issues identified by providers and internal staff.
• Communicates contract provisions with leadership and key personnel to ensure appropriate implementation of contract terms, including system configuration build.
• Ensures all contracts are properly drafted and executed.
• Conducts an analysis of potential network providers to assess potential business compatibility.
• Audits and troubleshoots negotiated reimbursement terms with claims and contract compliance systems.
• Maintains current knowledge of appropriate contractual provisions and of government regulations related to the establishment and maintenance of contractual arrangements.
• Represents provider relations and contracting department at meetings. Develops presentations for in-services, training and provider outreach activities.
• Participates in the development of contracting strategies, negotiation and effective administration for all University of Utah Health Plan product lines.

Knowledge / Skills / Abilities

• Ability to perform the essential functions of the job as outlined above.
• Strong oral and written communication skills to effectively communicate with a broad array of internal and external contacts.
• Proven ability to build and maintain positive relationships with large and complex institutional and professional providers.
• Knowledge and understanding of the provider community and principles of healthcare delivery systems.
• Strong knowledge of managed care reimbursement methodologies, including APDRG, Per Diem, Global Case Rates, Shared-risk Arrangements, RVU, etc.
• Knowledge of legal principles and contract language.
• Self-motivated with effective time management skills.
• Strong knowledge of healthcare operations and billing principles.
• Strong analytical and problem solving abilities.
• Intimate knowledge using word processing, spreadsheet, database, internet and e-mail applications.
• Knowledge of ICD9 and CPT codes.

Required

• Bachelor's degree in Business or Health Care Administration, Accounting, Nursing, or the equivalency.
• Five years of progressively more responsible provider relations, managed care or contract related experience.

Preferred

• • Master's degree in Business, Health Care Administration, or the equivalency.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.