Director, Provider Contracting

🔥 12 hours ago

🌽 Illinois, Montana, +4 more states – Remote

🌽 Illinois – Remote 🦬 Montana – Remote 🌶️ New Mexico – Remote 🌪️ Oklahoma – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

💵 $121.2k - $225.2k / year

⏰ Full Time

🔴 Lead

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Develop and manage contracting strategies for commercial and government networks • Develop, negotiate, and complete reimbursement contracts • Ensure network adequacy for commercial and government networks • Draft reimbursement agreements and negotiate contracts for hospitals, large professional groups with special pricing, and hospital-based physicians • Achieve competitive advantage in discounts and access through contract negotiations and relationship management • Develop strategies and negotiate contracts for newly recognized provider categories • Oversee analysis and reporting for reimbursement strategies and take corrective action as needed • Resolve issues and contractual disputes • Oversee staff, ensuring goals are met, positions are filled, training is provided, and communications are shared • Manage budget, operational reporting, and financial reporting • Communicate with co-workers, management, customers, and leadership • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable policies • Maintain confidentiality of company business • Perform special projects as required or requested • Travel as needed, including overnight stays

🎯 Requirements

• 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 • Knowledge of outpatient and provider reimbursement strategies and policies • Experience with financial matters such as contract performance and impact • Experience developing creative, win-win solutions involving provider contracts, networks, marketability, and profitability • Negotiation skills • Leadership skills • Clear and concise verbal and written communication skills, including interpersonal, presentation, and team-building skills • Experience meeting deadlines and working well under pressure • Experience working across departments to accomplish initiatives and goals, build consensus, drive initiatives, gain support, and develop workable solutions • Ability and willingness to travel, including overnight stays • Experience overseeing budgets and allocating resources • Ability to translate needs and initiatives into compelling business cases • Ability to conduct cost-benefit analyses to justify investments and ensure ROI • Remote employees must live within the continental United States, excluding Alaska, California, Hawaii, or New York • Sponsorship is not available

🏖️ Benefits

• Curated development plans and professional development • 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 • Annual incentive bonus plan • Other incentives