Senior Provider Contracting Consultant

Highmark Inc.

This is a Hybrid role and will require you to be onsite three days a week (Tuesdays, Wednesdays, and Thursdays).

This job serves as the primary contact for hospital negotiations. The incumbent is responsible for completion of annual provider contracting activities and ongoing contract management activities. Works regularly with senior leadership both within Highmark and with the provider on negotiations and other initiatives directed at building strategic relationships. This role is primarily focused externally (negotiations, etc.) but also acts as a subject matter expert (SME) for internal projects, etc.

Essential Responsibilities

• Lead negotiation of assigned mid-sized and large hospitals and health systems reimbursement and contractual terms. Represent Highmark external during such negotiations, with additional support as needed. Development and execution of work plans and strategy for assigned provider contracts.
• Execute Highmark provider contracting strategy related to hospital reimbursement and contracting. This includes contract standardization, internal cost savings efforts, and ongoing attention to unit cost trends.
• Primary Highmark contact, and/or relationship owner for assigned hospitals. Support Director, Vice President, and other members of senior leadership for any activities related to assigned hospital providers.
• Responsible for end-to-end provider contract administration and maintenance for assigned hospital providers. Work with internal team members and other areas of Highmark to effectively negotiate and implement provider agreements.
• Mentor a team of Provider Contract Consultants and Analysts in the development and assessment of pricing proposals and provider profile information for contract negotiations.
• Support Provider Contracting departmental activities and initiatives including process improvement efforts as needed.
• Other duties as assigned.

Education

Required

• Bachelor's Degree

Substitution

• 6 years of healthcare experience in lieu of a bachelor's degree

Preferred

• Master's Degree

Experience

Required

• 5 years in the Health Insurance industry
• 1 years with Provider Contract Negotiations

Preferred

• None

Skills

• Negotiation
• Contract Management
• Contracts Review
• Written & Oral Presentation Skills
• Problem Solving & Decision Making
• Provider Contracts
• Leadership

Language: (Other than English)

None

Travel Requirement

0% to 25%

Physical, Mental and Working Conditions

Position type

Office-based

Teaches / trains others regularly Occasionally

Travel regularly from the office to various work sites or from site-to-site Frequently

Works primarily out-of-the office selling products/services (sales employees)

Rarely

Physical work site required:

Yes

Lifting: up to 10 pounds Constantly

Lifting: 10 to 25 pounds Occasionally

Lifting: 25 to 50 pounds Rarely