Executive Director, Provider Contracting- Work from home

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Job Summary

This position is responsible for overall provider relations and also oversees the following: the development and management of network strategies, contract drafting, reimbursement contract negotiations, and servicing for hospitals for HMO and PPO products and networks to support Medicare advantage and Medicaid programs. This position is responsible for ensuring contracted network coverage and for oversight of management and staff who manage contracting operations nationally. Ability and willingness to travel.

Job Responsibilities:

1. Develop and manage contracting strategies for statewide operations relative to commercial HMO and PPO.

2. Accountable for the development, negotiation and successful completion of reimbursement contracts. Ensure appropriate coverage of networks for locations.

3. 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.

4. Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.

5. Develop strategies, draft agreements and negotiate contracts for newly recognized categories of providers.

6. Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed.

7. Oversee the performance of hospital audits and appropriate reimbursement of hospital costs.

8. Accountable for resolution of issues and contractual disputes.

9. Ensure staff meets/exceeds goals, objectives and initiatives. Ensure staff is trained, positions are filled, and employees receive communications on changes, etc.

10. Accountable for budget, operational reporting and financial reporting.

11. Communicate and interact effectively and professionally with co-workers, management, customers, etc.

12. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

13. Maintain complete confidentiality of company related business.

14. Maintain effective communication with Vice President, Network Management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS:

• 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

PREFERRED JOB REQUIREMENTS:

• MBA or Masters in Health Administration.
• Experience developing and executing national or multi-market contracting strategies.
• Experience negotiating value based care and risk arrangements

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• Please note: This is a Telecommute (Remote) role. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii or New York. Sponsorship is not available

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$161,500.00 - $299,700.00

Exact compensation may vary based on skills, experience, and location.