Senior Provider Contracting Consultant

Highmark Health; Camp Hill (Cumberland County); Hybrid; USD 80,000 - 110,000; Full time

Job summary

Highmark Health is seeking a Provider Contract Manager with extensive experience in the health insurance sector. This hybrid role involves leading negotiations with hospitals, managing contracts, and mentoring team members. A Bachelor's degree is required, and strong negotiation skills are essential for success in this position.

Qualifications

• Bachelor's Degree required or 6 years of healthcare experience.
• 5 years in the Health Insurance industry is required.
• 1 year with Provider Contract Negotiations required.

Responsibilities

• Lead negotiation of assigned hospital contracts.
• Responsible for end-to-end contract administration.
• Mentor a team for pricing proposals.

Skills

Negotiation

Contract Management

Contracts Review

Written & Oral Presentation Skills

Problem Solving & Decision Making

Provider Contracts

Leadership

Education

Bachelor's Degree

Master's Degree

Job description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

***This is a Hybrid role and will require you to be onsite 3 days a week (Tuesdays, Wednesdays, & Thursdays).

This jobserves as the primary contact for hospital negotiations. The incumbent is responsible for completion of annual provider contracting activities and ongoing contract management activities.Works regularly with senior leadership both within Highmark and with the provider on negotiations and other initiatives directed at building strategic relationships. This role is primarily focused externally (negotiations, etc.) but also acts a subject matter expert (SME) for internal projects, etc.

ESSENTIAL RESPONSIBILITIES

• Lead negotiation of assigned mid-sized and large hospitals and health systems reimbursement and contractual terms. Represent Highmark external during such negotiations, with additional support as needed. Development and execution of work plans and strategy for assigned provider contracts.
• Execute Highmark provider contracting strategy related to hospital reimbursement and contracting. This includes contract standardization, internal cost savings efforts, and ongoing attention to unit cost trends.
• Primary Highmark contact, and/or relationship owner for assigned hospitals. Support Director, Vice President, and other members of senior leadership for any activities related to assigned hospital providers.
• Responsible for end-to-end provider contract administration and maintenance for assigned hospital providers. Work with internal team members and other areas of Highmark to effectively negotiate and implement provider agreements.
• Mentor a team of Provider Contract Consultants and Analysts in the development and assessment of pricing proposals and provider profile information for contract negotiations.
• Support Provider Contracting departmental activities and initiatives including process improvement efforts as needed.
• Other duties as assigned.

EDUCATION

Required

• Bachelor's Degree

Substitution

• 6 years of healthcare experience in lieu of a bachelor's degree

Preferred

• Master's Degree

EXPERIENCE

Required

• 5 years in the Health Insurance industry
• 1 years with Provider Contract Negotiations

Preferred

• None

SKILLS

• Negotiation
• Contract Management
• Contracts Review
• Written & Oral Presentation Skills
• Problem Solving & Decision Making
• Provider Contracts
• Leadership

Language: (Other than English)

None

Travel Requirement

0% to 25%

PHYSICAL, MENTAL and WORKING CONDITIONS

Position type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Frequently

Works primarily out-of-the office selling products/services (sales employees)

Rarely

Physical work site required:

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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