Executive Director, Provider Contracting- Work from home

About the role

This position is responsible for overall provider relations and also oversees the development and management of network strategies, contract drafting, reimbursement contract negotiations, and servicing for hospitals for HMO and PPO products and networks to support Medicare Advantage and Medicaid programs. This position is responsible for ensuring contracted network coverage and for oversight of management and staff who manage contracting operations nationally. Ability and willingness to travel.

Responsibilities

• Develop and manage contracting strategies for statewide operations relative to commercial HMO and PPO.
• Accountable for the development, negotiation and successful completion of reimbursement contracts.
• Ensure appropriate coverage of networks for locations.
• Develop network, draft reimbursement agreements and negotiate reimbursement contracts for hospitals, large professional groups, ancillary providers, and hospital based physicians, for Commercial HMO and PPO, Medicare Advantage and Medicaid networks.
• Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
• Develop strategies, draft agreements and negotiate contracts for newly recognized categories of providers.
• Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed.
• Oversee the performance of hospital audits and appropriate reimbursement of hospital costs.
• Accountable for resolution of issues and contractual disputes.
• Ensure staff meets/exceeds goals, objectives and initiatives.
• Ensure staff is trained, positions are filled, and employees receive communications on changes, etc.
• Accountable for budget, operational reporting and financial reporting.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company related business.
• Maintain effective communication with Vice President, Network Management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
• Overseeing the annual budget and allocating resources for various projects and operational needs.
• Translating needs and initiatives into compelling business cases.
• Conducting cost-benefit analyses to justify investments and ensure ROI.

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 health care/insurance administration, hospital/health care contracting, and hospital/physician relations.
• 7 years management experience.
• Knowledge of hospital and provider reimbursement strategies and policies.
• Clear and concise verbal and written communications skills including interpersonal skills to represent company to external entities, negotiate contracts, resolve issues, and prepare executive and employee presentations.
• Leadership skills, team player, relationship building skills.
• Experience working in a fast paced environment and meeting deadlines.
• Accuracy and sound judgment with regard to financial matters such as contract performance and impact.
• Negotiation skills.
• Ability and willingness to travel.

Qualifications

• MBA or Masters in Health Administration.
• Experience developing and executing national or multi-market contracting strategies.
• Experience negotiating value based care and risk arrangements.

Pay

$161,500.00 - $299,700.00. Exact compensation may vary based on skills, experience, and location.

Schedule

This is a Telecommute (Remote) role. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii or New York.