Remote Director, Healthcare Network Development & Contracts

MedRisk; Conshohocken (Montgomery County); On-site; USD 180,000 - 260,000; Full time

Job summary

HCS is seeking a director to lead and support the development, negotiation, management, and maintenance of provider contracts for physician organizations, hospitals, and ancillary facilities. The role spans all payment arrangements and requires building strategies, negotiating with executives, and ensuring compliance with regulatory standards.

The candidate will lead a team of specialists, collaborate with senior leadership and data analytics, and represent the organization at industry events,

Qualifications

• Bachelor’s degree required in Business, Healthcare Administration, or Public Health or relevant experience in lieu of degree in health or health care related field.
• Requires a minimum of 10 years demonstrated business experience in hospital and provider group finance and/or managed care network development.
• Requires a minimum 10 years in-depth knowledge and understanding of contract finance and reimbursement methodologies including FFS, Workers Compensation/PIP pricing, and incentive arrangements.
• Requires a minimum of 10 years prior provider experience in a healthcare setting including but not limited to Workers Compensation, PIP, Commercial, and/or Value Based Programs is required.
• Requires a minimum of 5-8 years’ experience in health care cost data analysis.
• Requires a minimum of 5-8 years supervisory experience and/or leading people by influence.

Responsibilities

• Manage and negotiate contracts in compliance with HCS reimbursement standards.
• Assist and implement provider contracting policies and procedures that are consistent with industry best practices and regulatory requirements.
• Ensures accurate implementation of contracts in addition to working with other departments to assure contract and special arrangement reporting, provider database maintenance requests, and new hospital implementation.
• Conducts research, identify root cause analysis and work fall out reports causing operational deficiencies.
• Manages the maintenance of all provider contract language and templates and ensures that all negotiated contracts can be configured into the HCS systems.
• Collaborates with Legal and Compliance as needed to modify provider contract templates to ensure compliance with all regulatory, accreditation and business requirements.
• Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance all lines of business.
• Coordination across network management for the submission of hospital, ancillary and professional rate loads, pricing configurations, and contract storage.
• Manages the effectiveness and efficiencies of operations which includes management of contract inventory and adherence to all regulatory requirements and internal policies and procedures.
• Understand the credentialing and recredentialing process, provider directory maintenance, and regulatory standards.
• Collaborate across departments to ensure that provider services are aligned with the needs of claimants and the organization.
• Assist with keeping the provider network integrated with the organization’s objectives.
• Provide management level leadership and support all of the contracting staff.
• Assist the team with skills, knowledge, and resources needed to effectively manage the provider network and achieve team goals.
• Represent the organization at industry conferences, webinars, and other events.

Skills

Business relationships

Analytical skills

Business cases

Sound judgment

Questioning skills

Detail oriented

Organizational skills

Problem solving

Communication skills

Team player

Education

Bachelor’s degree

Master’s degree preferred

Relevant experience in lieu of degree

Tools

MS Office

Job description

HCS is seeking a director to lead and support the development, negotiation, management, and maintenance of provider contracts for physician organizations, hospitals, and ancillary facilities. The role spans all payment arrangements and requires building strategies, negotiating with executives, and ensuring compliance with regulatory standards.

The candidate will lead a team of specialists, collaborate with senior leadership and data analytics, and represent the organization at industry events,