Description
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!
Job Summary This position is responsible for national contract negotiations, network development activities, and strategy development/implementation for designated health care providers. Objectives of this position includes improving or maintaining network competitive discounts, converting percent of charge pricing to fixed pricing, developing, and implementing innovative payment methodologies and working with other internal departments to implement alternative payment programs and value-based care models with physicians and/or hospitals. This position may also manage ancillary provider contracting staff to be located at multiple sites throughout the state. Ability and willingness to travel, including overnight stays.Responsibilities include:
1. Develop and renegotiate reimbursement contracts and strategies with national health care providers which include one or more of the following: hospitals, physician groups, and ancillary care providers.
2. Develop network(s), drafts reimbursement agreements, and negotiate reimbursement contracts for designated health care providers to support commercial networks and Medicare Advantage and Medicaid programs.
3. Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
4. Identify and implement opportunities to improve pricing models and methodologies to achieve predictability, administrative efficiency, and transform payments from fee-for-service to fee-for-value.
5. Coordinate contracting with staff who may report directly to other Directors and Managers within Network Management, as needed.
6. Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed
7. Oversee the performance of negotiated health care provider compensation and appropriate reimbursement of medical costs
8. Analyze monthly activity reports, budget and variance reports and formulate resolutions for problem trends.
9. Identify deficiencies in reporting capabilities and coordinate development and implementation of needed methodologies.
10. Develop, implement and maintain processes and standards for provider network expansion, contracting and servicing. Ensure that quality standards regarding the provider network are met.
11. Directly manage staff including but not limited to: hiring, performance management, talent management, training, counseling, Affirmative Action, pay administration and change management.
12. Assist in presentations to existing and potential customers.
13. Provide network information for the preparation of Requests for Proposals.
14. Analyze the networks on a regular basis for provider accessibility and availability to determine appropriate action needed to ensure compliance with state Department of Insurance regulations and HCSC state guidelines.
15. Serve on local, regional, and corporate committees and task force when requested.
16. Communicate and interact effectively and professionally with co-workers, management, customers, etc.
17. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
18. Maintain complete confidentiality of company related business.
19. Maintain effective communication with leadership regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
* Bachelor's degree plus 5 years' experience in hospital/health care contracting, and hospital/physician relations
* 5 years management experience
* Experience working with large national providers and complex reimbursement strategies
* Experience proactively developing and maintaining relationships with health care provider leadership teams with propensity to build trust
* Knowledge of outpatient and provider reimbursement strategies and policies
* Experience with financial matters such as contract performance and impact including accuracy and sound judgment
* Experience proactively developing creative, win-win solutions considering the impact on the provider contract, network, marketability of the product, and profitability of the product
* Negotiation skills
* Leadership skills
* Team player/relationship oriented
* Clear and concise verbal and written communications skills including interpersonal skills, presentation skills to present to executives internally and externally, and team building
* Experience meeting deadlines and work well under pressure
* Experience working across departments to accomplish initiatives and goals, building consensus, driving initiatives, gaining support and developing workable solutions
* Ability and willingness to travel, including overnight stays
PLEASE NOTE - This is a HYBRID role requiring in-office hours 3 days a week.
PREFERRED QUALIFICATIONS:
* National commercial network development, provider relations and contracting experience
* Financial acumen & data analytics
* Knowledge of provider pricing and reimbursement structures
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HCSC Employment Statement:HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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