Executive Director, Provider Contracting- Work from home

HCSC Group; Northern (KY); Hybrid; USD 162,000 - 300,000; Full time

Job summary

HCSC in the United States seeks a seasoned Contracting Director to develop and manage contracting strategies for commercial and government networks, draft reimbursement agreements, and oversee staff who handle contracting operations.

This leadership role requires extensive experience in hospital and provider reimbursement, strong negotiation and budgeting skills, and the ability to work cross-functionally in a matrixed environment.

Qualifications

• Bachelor degree and 15 years experience in health care/insurance administration, hospital/health care contracting, and hospital/physician relations OR 19 years experience in health care/insurance administration, hospital/health care contracting, and hospital/physician relations.
• 7 years management experience.
• Knowledge of hospital and provider reimbursement strategies and policies.
• Clear and concise verbal and written communications skills including interpersonal skills to represent company to external entities, negotiate contracts, resolve issues, and prepare executive and employee presentations.
• Leadership skills, team player, relationship building skills.
• Experience working in a fast-paced environment and meeting deadlines.
• Ability to work cross-functionally with colleagues across a highly matrixed environment.
• Accuracy and sound judgment with regard to financial matters such as contract performance and impact.
• Negotiation skills.
• Overseeing the annual 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
• MBA or Masters in Health Administration.
• 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.

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 Vice President, Network Management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

Skills

Negotiation

Leadership

Verbal and written communication

Cross-functional collaboration

Budgeting/financial analysis

Project management

Education

Bachelor's degree in health care/insurance administration

MBA or Masters in Health Administration (preferred)

Job description

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 management and 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 Vice President, Network Management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

Job Requirements

• Bachelor degree and 15 years experience in health care/insurance administration, hospital/health care contracting, and hospital/physician relations OR 19 years experience in health care/insurance administration, hospital/health care contracting, and hospital/physician relations.
• 7 years management experience.
• Knowledge of hospital and provider reimbursement strategies and policies.
• Clear and concise verbal and written communications skills including interpersonal skills to represent company to external entities, negotiate contracts, resolve issues, and prepare executive and employee presentations.
• Leadership skills, team player, relationship building skills.
• Experience working in a fast-paced environment and meeting deadlines.
• Ability to work cross-functionally with colleagues across a highly matrixed environment.
• Accuracy and sound judgment with regard to financial matters such as contract performance and impact.
• Negotiation skills.
• Overseeing the annual 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 Qualifications

• MBA or Masters in Health Administration.
• #LI-TR1 INJLF 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. 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.

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

Base Pay Range $161,500.00 - $299,700.00 Exact compensation may vary based on skills, experience, and location.

Additional Information

Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities. Join our Talent Community. 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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