Director of Provider Contracting

About the role

We are a Colorado-based company dedicated to improving the health of our state. Our mission is to drive improvements in quality, member experience, outcomes, and cost. We believe in a mission-driven organization that is built on diversity, equity, and inclusion.

Responsibilities

• Develop strategic direction and oversee the management and maintenance of department deliverables striving for operational excellence.
• Builds high performing teams with vision, leadership, goals and metrics.
• Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives.
• Provides awareness to staff how their work impacts other departments, programs and the enterprise.
• Encourages collaboration and holds team members accountable for achieving outstanding results.
• Responsible for all management functions including hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees; corrective action procedures and practices, addressing complaints and resolving problems.
• Develops and manages the department budget.
• Works closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
• Oversees/leads departmental projects and continuous improvement initiatives; may lead cross functional teams.
• Develops and implements department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.
• Oversees COA provider contracting function; responsible for leading the daily operations of the department and collaborating with other operational departments and functional business unit stakeholders to lead or support various provider contracting functions.
• Responsible for strategy development of a high performing network in consultation with Company executive management, legal counsel, medical management staff, and others.
• Supports and leads implementation of contracting software and client relationship management tools.
• Sets strategic direction for the contracting department that aligns with organizational goals and sets continuous improvement goals aligned with NCQA requirements, HCPF requirements, and DOI standards.
• Ability to successfully negotiate complex contracts with a variety of provider types, including but not limited to primary care, hospital systems and behavioral health providers.
• Ability to develop and implement efficient contracting processes, to create and refine contract amendment approval process, and effectively communicate changes to all relevant departments.
• Collaborates closely with the Network Management Team to ensure network adequacy and network goals are met.
• Participates in Joint Operating Committee (JOCs) meetings with key providers and representatives from all aspects of corporate operations including claims, grievance and appeals, medical management, etc.
• Analyzes the financial results of current contract payment platforms and assesses the need and fiscal impact of altering the payment platforms.

Requirements

• Education: Bachelor’s degree in a relevant field is required. Master’s degree preferred.
• Experience: Minimum of 7 years health plan or health system provider contracting experience with 5 years of management experience required.

Skills and Abilities

• Extensive knowledge of health plan and/or health system contracting, provider reimbursement and claims payment, medical terminology, and health care delivery systems required.
• Good knowledge of local health and community agencies and providers preferred.
• Strategic business planning, change management, people management and project management skills required.
• Demonstrates support for the company’s mission, vision and values.
• Must have excellent negotiation skills and techniques and be up to date on negotiation strategies.
• Excellent written and public speaking communication skills.
• Strong interpersonal, relationship building, and strategic partnership development skills with ability to deal with multiple levels of staff.
• Training, project development and management skills required.
• Strong attention to detail with excellent organizational and time management skills to multi-task and handle high volume workload.
• Proficient in Microsoft Office applications (Word, Excel, PowerPoint).

Benefits

• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility)
• Annual bonus program (based on eligibility, requirements and performance)

Pay

The compensation for this position is $150,700.00 - $185,600.00 annually.

Schedule

This position will be a hybrid model work environment, a blend of 'In-Office' and 'Remote.'