Senior Provider Contracting Consultant

Highmark; Camp Hill (Cumberland County); Hybrid; USD 90,000 - 130,000; Full time

Job summary

A leading company in the health insurance sector is seeking a Senior Provider Contracting Consultant for its Camp Hill location. The role involves leading negotiations with hospitals and managing provider contracts. Candidates should have significant experience in the health insurance industry and proven negotiation skills. Success in this position will enhance strategic relationships and contract management effectiveness.

Qualifications

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

Responsibilities

• Lead negotiation of provider contracts with hospitals and health systems.
• Responsible for end-to-end contract administration.
• Mentor a team in pricing proposals and negotiations.

Skills

Negotiation

Contract Management

Contracts Review

Written & Oral Presentation Skills

Problem Solving & Decision Making

Provider Contracts

Leadership

Education

Bachelor's Degree

Master's Degree

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

Job description

Join to apply for the Senior Provider Contracting Consultant role at Highmark

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Join to apply for the Senior Provider Contracting Consultant role at Highmark

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

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 job serves 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.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [e-mail]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Consulting, Information Technology, and Sales

• Industries

  Insurance

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