Director, Provider Contracting- Work from home

Health Care Service Corp.; Brooklyn Heights (TN); Remote; USD 121,000 - 225,000; Full time

Job summary

Health Care Service Corporation is seeking a contracting leader to develop and manage network strategies, draft reimbursement agreements, and negotiate contracts for commercial and government networks. You will oversee contracting operations staff and ensure network coverage while analyzing provider compensation programs.

Travel is required. The role emphasizes leadership, strategic collaboration, and risk management within a large health care delivery system.

Qualifications

• Bachelor’s degree plus 5 years’ experience in hospital/health care contracting or hospital/physician relations
• 5 years management experience
• Experience with large integrated health care delivery systems and complex reimbursement strategies
• Experience proactively developing and maintaining relationships with health care provider leadership teams
• Knowledge of outpatient and provider reimbursement strategies and policies
• Experience with financial matters such as contract performance and impact including accuracy and sound judgment
• Experience proactively developing creative, win-win solutions considering impact on provider contract, network, marketability, profitability
• Negotiation skills and Leadership skills
• Team player/relationship oriented with strong communication
• Experience meeting deadlines and working under pressure
• Cross-department collaboration and building consensus
• Ability and willingness to travel, including overnight stays
• Overseeing budget and allocating resources for projects
• Translating needs into compelling business cases
• Conducting cost-benefit analyses to justify investments and ROI

Responsibilities

• Develop contracting strategies for operations relative to commercial and government networks
• Negotiate and complete reimbursement contracts ensuring network adequacy
• Draft reimbursement agreements for hospitals and large professional groups
• Negotiate contracts for newly recognized provider categories
• Oversee analysis and reporting to develop reimbursement strategies
• Resolve contractual disputes and ensure staff meet goals and training
• Manage budget and operational/financial reporting
• Communicate professionally with stakeholders and comply with policies
• Travel as required to manage relationships and initiatives

Skills

Negotiation skills

Leadership

Communication

Team player

Budget management

Travel willingness

Education

Bachelor’s degree in healthcare contracting

Job description

Job Summary

This position is responsible for the following: the development and management of network strategies, contract drafting, reimbursement contract negotiations, and servicing for hospitals, ancillary, and professional providers for commercial and government networks. This position is responsible for ensuring contracted network coverage and for oversight of staff who manage contracting operations. This position is accountable for the analysis and outcomes of provider compensation programs for commercial and government networks. Ability and willingness to travel.

Job Responsibilities

• Develop and manage contracting strategies for operations relative to commercial and government networks.
• Accountable for the development, negotiation, and successful completion of reimbursement contracts. Ensure network adequacy for commercial and government networks.
• Develop network, draft reimbursement agreements, and negotiate reimbursement contracts for hospitals, large professional groups with special pricing, and hospital-based physicians, for commercial and government networks.
• Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
• Develop strategies, draft agreements, and negotiate contracts for newly recognized categories of providers.
• Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed.
• Accountable for resolution of issues and contractual disputes.
• Ensure staff meets/exceeds goals, objectives and initiatives. Ensure staff is trained, positions are filled, and employees receive communications on changes, etc.
• Accountable for budget, operational reporting and financial reporting.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company related business. Maintain effective communication with leadership within the organization regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

Job Requirements

• Bachelor’s degree plus 5 years’ experience in hospital/health care contracting or hospital/physician relations
• 5 years management experience
• Experience working with large integrated health care delivery systems and complex reimbursement strategies
• Experience proactively developing and maintaining relationships with health care provider leadership teams with propensity to build trust
• Knowledge of outpatient and provider reimbursement strategies and policies
• Experience with financial matters such as contract performance and impact including accuracy and sound judgment
• Experience proactively developing creative, win-win solutions considering the impact on the provider contract, network, marketability of the product, and profitability of the product
• Negotiation skills
• Leadership skills
• Team player/relationship oriented
• Clear and concise verbal and written communications skills including interpersonal skills, presentation skills to present to executives internally and externally, and team building
• Experience meeting deadlines and work well under pressure
• Experience working across departments to accomplish initiatives and goals, building consensus, driving initiatives, gaining support and developing workable solutions
• Ability and willingness to travel, including overnight stays
• Overseeing the budget and allocating resources for various projects and operational needs.
• Translating needs and initiatives into compelling business cases.
• Conducting cost-benefit analyses to justify investments and ensure ROI.

Preferred Job Requirements

• Bachelor’s degree
• Hospital contracting experience

Telecommute (Remote)

Please note: This is a Telecommute (Remote) role. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii or New York. Sponsorship is not available.

Pay Transparency Statement

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Base Pay Range $121,200.00 - $225,200.00 Exact compensation may vary based on skills, experience, and location.

Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations.