Director, Provider Contracting
Health Care Service Corporation
Director, Provider Contracting – MA Markets
Health Care Service Corporation
full-time
Posted on:
Location Type: Hybrid
Location: Chicago • Illinois, Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $118,800 - $220,800 per year
Job Level
Lead
About the role
- Develop and renegotiate reimbursement contracts and strategies with health care providers which include one or more of the following: hospitals, physician groups, and other designated health care providers.
- Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
- Identify and implement opportunities to improve pricing models and methodologies to achieve predictability, administrative efficiency, and transform payments from fee-for-service to fee-for-value.
- Coordinate contracting with staff who may report directly to other Directors and Managers within Network Management, as needed.
- Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed.
- Oversee the performance of negotiated health care provider compensation and appropriate reimbursement of medical costs.
- Analyze monthly activity reports, budget and variance reports and formulate resolutions for problem trends.
- Identify deficiencies in reporting capabilities and coordinate development and implementation of needed methodologies.
- Develop, implement and maintain processes and standards for provider network expansion, contracting and servicing. Ensure that quality standards regarding the provider network are met.
- Directly manage staff including but not limited to: hiring, performance management, talent management, training, counseling, pay administration and change management.
- Assist in presentations to existing and potential customers.
Requirements
- Bachelor’s degree plus 5 years’ experience in hospital/health care contracting, and hospital/physician relations
- 5 years management experience
- Experience working with large integrated health care delivery systems and complex reimbursement strategies
- Experience proactively developing and maintaining relationships with health care provider leadership teams with propensity to build trust
- Knowledge of outpatient and provider reimbursement strategies and policies
- Experience with financial matters such as contract performance and impact including accuracy and sound judgment
- Experience proactively developing creative, win-win solutions considering the impact on the provider contract, network, marketability of the product, and profitability of the product
- Negotiation skills
- Leadership skills
- Team player/relationship oriented
- Clear and concise verbal and written communications skills including interpersonal skills, presentation skills to present to executives internally and externally, and team building
- Experience meeting deadlines and work well under pressure
- Experience working across departments to accomplish initiatives and goals, building consensus, driving initiatives, gaining support and developing workable solutions
- Ability and willingness to travel, including overnight stays
- 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.
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
- other incentives
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
hospital contractinghealth care contractingreimbursement strategiespricing modelscontract negotiationsfinancial analysisbudget managementcost-benefit analysisprovider reimbursement policiesnetwork expansion
Soft skills
negotiation skillsleadership skillsrelationship managementcommunication skillsteam buildingproblem-solvingtime managementinterpersonal skillspresentation skillsconsensus building
Certifications
Bachelor's degree
