Executive Director, Provider Contracting- Work from home

Health Care Service Corporation; Richardson (TX); On-site; USD 162,000 - 300,000; Full time

Job summary

Health Care Service Corporation is seeking a senior contracting leader to develop and manage statewide contracts for commercial HMO and PPO networks, including Medicare Advantage and Medicaid as applicable.

This telecommute role in the continental United States requires extensive experience in hospital/physician contracting, budget oversight, and strategic negotiation, with travel as needed to meet objectives.

Qualifications

• Bachelor degree and extensive experience in health care contracting or hospital relations.
• Demonstrated leadership and ability to manage contracts and budgets.
• Strong negotiation, communication and stakeholder engagement skills.
• Willingness to travel as part of role requirements.

Responsibilities

• Develop and manage statewide contracting strategies for commercial HMO and PPO networks.
• Negotiate reimbursement contracts and ensure network coverage for locations.
• Oversee hospital audits and reimbursement of costs; monitor contract performance.
• Lead staff, budgets, and operational reporting; ensure training and compliance.
• Collaborate with executives and external entities to advance contracting goals.

Skills

Contract negotiations

Healthcare contracting

Leadership

Budget management

Communication

Travel willingness

Education

Bachelor's degree

MBA or Masters in Health Administration

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.

Job Responsibilities

• Develop and manage contracting strategies for statewide operations relative to commercial HMO and PPO.
• Accountable for the development, negotiation and successful completion of reimbursement contracts. Ensure appropriate coverage of networks for locations.
• Develop network, draft reimbursement agreements and negotiate reimbursement contracts for hospitals, large professional groups, ancillary providers, and hospital based physicians, for Commercial HMO and PPO, Medicare Advantage and Medicaid 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.
• Oversee the performance of hospital audits and appropriate reimbursement of hospital costs.
• 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.
• Accuracy and sound judgment with regard to financial matters such as contract performance and impact
• Negotiation skills.
• Ability and willingness to travel.
• 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 Requirements

• MBA or Masters in Health Administration.
• Experience developing and executing national or multi-market contracting strategies.
• Experience negotiating value based care and risk arrangements

• 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

Compensation: $161,500.00 - $299,700.00

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

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards