Executive Director, Provider Contracting

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois, Oklahoma, +2 more states – Remote

🌽 Illinois – Remote 🌪️ Oklahoma – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

💵 $161.5k - $299.7k / year

⏰ Full Time

🔴 Lead

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Oversee overall provider relations • Develop and manage network strategies for commercial HMO and PPO operations • Draft, negotiate, and complete reimbursement contracts • Ensure appropriate network coverage for locations • Develop networks and negotiate contracts for hospitals, professional groups, ancillary providers, and hospital-based physicians across Commercial HMO and PPO, Medicare Advantage, and Medicaid networks • Achieve competitive 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 • Oversee hospital audits and appropriate reimbursement of hospital costs • Resolve issues and contractual disputes • Oversee contracting operations nationally and manage staff performance, training, staffing, and communications • Manage budgets, operational reporting, and financial reporting • Communicate with co-workers, management, customers, and external entities • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable policies • Maintain confidentiality of company business • Communicate developments to the Vice President, Network Management and perform special projects as requested • Travel as required

🎯 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 these areas • 7 years management experience • Knowledge of hospital and provider reimbursement strategies and policies • Clear and concise verbal and written communication skills, including interpersonal skills • Ability to represent the company to external entities, negotiate contracts, resolve issues, and prepare executive and employee presentations • Leadership, teamwork, and relationship-building skills • Experience working in a fast-paced environment and meeting deadlines • Accuracy and sound judgment regarding financial matters such as contract performance and impact • Negotiation skills • Ability and willingness to travel • Experience overseeing annual 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 • Sponsorship is not available • Remote employees must live within the continental United States, excluding Alaska, California, Hawaii, and New York • MBA or Masters in Health Administration preferred • Experience developing and executing national or multi-market contracting strategies preferred • Experience negotiating value based care and risk arrangements preferred

🏖️ Benefits

• Curated development plans and professional development • Annual incentive bonus plan • 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 • Remote work arrangement