Director, Provider Contracting- Work from home

HCSC; Helena (MT); Remote; USD 121,000 - 225,000; Full time

Job summary

Health Care Service Corporation is seeking a senior contracting professional to lead network contracting strategies for commercial and government networks. You will oversee negotiating reimbursement contracts, ensure network adequacy, and manage staff responsible for contracting operations.

The role requires extensive experience with provider reimbursement, strong negotiation skills, and the ability to travel as needed.

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
• Experience building relationships with health care provider leadership teams
• Knowledge of outpatient and provider reimbursement strategies and policies
• Experience with contract performance and financial matters
• Strong negotiation and leadership skills
• Ability and willingness to travel, including overnight stays
• Overseeing budget and allocating resources
• Translating needs into compelling business cases

Responsibilities

• Develop and manage contracting strategies for operations relative to commercial and government networks.
• Accountable for development, negotiation, and completion of reimbursement contracts.
• Develop networks, draft reimbursement agreements, and negotiate contracts for hospitals and large professional groups.
• Achieve competitive advantages through contract negotiations and relationship management.
• Develop strategies and negotiate contracts for newly recognized provider categories.
• Oversee analysis and reporting to develop reimbursement strategies and corrective actions.
• Resolve issues and contractual disputes.
• Ensure staff meet goals, are trained and informed of changes.
• Accountable for budget, operational reporting and financial reporting.
• Communicate effectively with coworkers, management, and customers.
• Comply with HIPAA and corporate policies.
• Maintain confidentiality and coordinate with leadership on developments.

Skills

Negotiation

Leadership

Communication

Travel readiness

Team collaboration

Contracting strategy

Education

Bachelor’s degree

Job description

Remote

TN - Nashville

MT - Helena

NM - Albuquerque

OK - Tulsa

IL - Chicago

TX - Richardson

Full time

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

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:

1. Develop and manage contracting strategies for operations relative to commercial and government networks.

2. Accountable for the development, negotiation, and successful completion of reimbursement contracts. Ensure network adequacy for commercial and government networks.

3. 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.

4. Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.

5. Develop strategies, draft agreements, and negotiate contracts for newly recognized categories of providers.

6. Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed.

7. Accountable for resolution of issues and contractual disputes.

8. Ensure staff meets/exceeds goals, objectives and initiatives. Ensure staff is trained, positions are filled, and employees receive communications on changes, etc.

9. Accountable for budget, operational reporting and financial reporting.

10. Communicate and interact effectively and professionally with co-workers, management, customers, etc.

11. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

12. Maintain complete confidentiality of company related business.

13. 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

INJLF

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

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

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.

HCSC 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.

Base Pay Range

$121,200.00 - $225,200.00

Exact compensation may vary based on skills, experience, and location.

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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.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

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