[Hiring] Director, Provider Contracting @Health Care Service Corporation

Role Description

This position is responsible for the following:

• Development and management of network strategies.
• Contract drafting and reimbursement contract negotiations.
• Servicing for hospitals, ancillary, and professional providers for commercial and government networks.
• Ensuring contracted network coverage and oversight of staff managing contracting operations.
• Analysis and outcomes of provider compensation programs for commercial and government networks.
• Ability and willingness to travel.

Job 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 leadership within the organization regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

Qualifications

• Bachelor’s degree plus 5 years’ experience in hospital/health care contracting or 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 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.

Requirements

• Bachelor’s degree.
• Hospital contracting experience.

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.

Company Description

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.

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.

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued.

Base Pay Range: $121,200.00 - $225,200.00. Exact compensation may vary based on skills, experience, and location.