Director of Provider Contracting
Job Summary/Purpose
The Director of Provider Contracting is responsible for the strategic leadership, financial oversight, and operational management of the health plan’s Provider Contracting Department within the Finance division of Samaritan Health Plans. This role oversees provider contract development, negotiation, reimbursement methodology design, and contract lifecycle management across all applicable lines of business. The Director will ensure alignment with financial objectives, actuarial assumptions, regulatory requirements, and organizational strategy.
Experience/Qualifications
Experience with contract financial forecasts or spend
Excellent communication skills
Knowledge of credentialing
Network adequacy and network management
Management of staff, budgets, contract negotiations, medicare and/or medicaid contract terms
Experience
Seven (7) years of experience in provider contracting, reimbursement strategy, or healthcare finance, including two (2) years leadership experience, required.
Experience in reimbursement methodologies, financial modeling, and healthcare regulatory requirements (Medicaid, Medicare Advantage, D-SNP, Commercial) required.
Experience negotiating with hospitals, physician groups, ancillary providers, and health systems required.
Experience collaborating with Finance, Actuarial, Legal, and Compliance departments required.
Knowledge/Skills/Abilities
Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
Critical thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
Communication and team building - Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
Physical Demands
Rarely (1 - 10% of the time): LIFT (Floor to Waist: 0"-36") 0-20 Lbs, LIFT (Knee to chest: 24"-54") 0 - 20 Lbs, LIFT (Waist to Eye: up to 54") 0 - 20 Lbs, CARRY 1-handed, 0 - 20 pounds, CARRY 2-handed, 0 - 20 pounds, KNEEL (on knees), BEND FORWARD at waist, CLIMB - STAIRS, STAND WALK - LEVEL SURFACE, ROTATE TRUNK, SIT ROTATE TRUNK, Sitting, REACH - Upward, PUSH (0-20 pounds force), PULL (0-20 pounds force)