Provider Contracting Director

The Provider Contracting Director serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager or VP of Contracting. This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.

Duties and responsibilities include:

• Managing complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers.
• Leading a team with direct reports.
• Being the point person for complex projects related to contracting strategy in the market.
• Building relationships that nurture provider partnerships and seek broader value-based business opportunities.
• Initiating and maintaining effective channels of communication with matrix partners.
• Managing strategic positioning for provider contracting, developing networks, and identifying opportunities for greater value-orientation.
• Contributing to the development of alternative network initiatives.
• Working to meet unit cost targets while preserving an adequate network.
• Creating and managing initiatives that improve total medical cost and quality.
• Driving change with external provider partners.
• Preparing, analyzing, reviewing, and projecting the financial impact of larger or complex provider contracts.
• Creating "HCP" agreements that meet internal operational standards and external provider expectations.
• Leading in resolving elevated and complex provider service complaints.
• Managing key provider relationships.
• Demonstrating knowledge of providers in an assigned geographic area.
• Being responsible for accurate and timely contract loading and submissions.

Position requirements include:

• A bachelor degree; preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree. MBA or MHA preferred.
• 5+ years Contracting and Negotiating experience involving complex delivery systems and organizations required.
• Experience focused on Commercial Health Insurance.
• Significant experience leading and mentoring others.
• Experience in developing and managing key provider relationships.
• Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred.
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
• Intimate understanding and experience with hospital, managed care, and provider business models.
• Team player with the proven ability to develop strong working relationships within a fast-paced, matrix organization.
• The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations.
• Customer centric and interpersonal skills are required.
• Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment.
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
• Knowledge and use of Microsoft Office tools.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

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