Director, Provider Contracting- MA Markets (SE Region)

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Job Summary

This position is responsible for contract negotiations, network development activities, and strategy development/implementation for designated health care providers. Objectives of this position includes overseeing the SE region of provider contracting in the Eastern region for MA markets for all FFC & VBC contracting, complex negotiations, and relationship management and interactions with health system executives.

Job Description

1. 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.
2. Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
3. 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.
4. Coordinate contracting with staff who may report directly to other Directors and Managers within Network Management, as needed.
5. Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed
6. Oversee the performance of negotiated health care provider compensation and appropriate reimbursement of medical costs
7. Analyze monthly activity reports, budget and variance reports and formulate resolutions for problem trends.
8. Identify deficiencies in reporting capabilities and coordinate development and implementation of needed methodologies.
9. Develop, implement and maintain processes and standards for provider network expansion, contracting and servicing. Ensure that quality standards regarding the provider network are met.
10. Directly manage staff including but not limited to: hiring, performance management, talent management, training, counseling, pay administration and change management.
11. Assist in presentations to existing and potential customers.
 

JOB 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.

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*This is a hybrid role, in office 3 days/week

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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$118,800.00 - $220,800.00

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