Remote Executive Director, Provider Contracting

Luminare Health Benefits Inc.; United States; Remote; USD 162,000 - 300,000; Full time

Job summary

Health Care Service Corporation (HCSC) is seeking a senior network contracting leader to develop and manage contracting strategies for commercial and government networks. You will negotiate reimbursement contracts, oversee staff, and ensure network adequacy while managing budgets and performance metrics.

The role requires extensive experience in health care contracting, strong negotiation and leadership skills, and the ability to work in a highly matrixed environment.

Qualifications

• Bachelor degree and 15 years experience in health care/insurance administration, hospital 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

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

Communication

Cross-functional

Education

Bachelor degree

MBA

Job description

Health Care Service Corporation (HCSC) is seeking a senior network contracting leader to develop and manage contracting strategies for commercial and government networks. You will negotiate reimbursement contracts, oversee staff, and ensure network adequacy while managing budgets and performance metrics.

The role requires extensive experience in health care contracting, strong negotiation and leadership skills, and the ability to work in a highly matrixed environment.