Remote Executive Director, Health Care Contracting

Health Care Service Corp.; Richardson (TX); Remote; USD 162,000 - 300,000; Full time

Job summary

Health Care Service Corporation (HCSC) seeks an experienced leader to oversee provider relations, network strategies, and hospital contracting for HMO and PPO products across Medicare Advantage and Medicaid. The role ensures contracted network coverage and manages national contracting operations, with travel as needed.

Responsibilities include developing contracting strategies for statewide and national networks, negotiating reimbursement agreements, overseeing audits and payments, and guiding

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.
• 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

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.

Skills

Provider reimbursement

Negotiation

Leadership

Communication

Travel willingness

Contracting

Education

Bachelor degree and 15+ years experience in health care/insurance administration or 19+ years experience

Job description

Health Care Service Corporation (HCSC) seeks an experienced leader to oversee provider relations, network strategies, and hospital contracting for HMO and PPO products across Medicare Advantage and Medicaid. The role ensures contracted network coverage and manages national contracting operations, with travel as needed.

Responsibilities include developing contracting strategies for statewide and national networks, negotiating reimbursement agreements, overseeing audits and payments, and guiding