Executive Director, Provider Contracting- HealthSpring- work from home

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Job Summary

This position is responsible overall provider contracting and oversees the following: the development and management of network strategies, contract drafting, reimbursement contract negotiations, and servicing products and networks to support Medicare Advantage programs. This position is accountable for the Health Spring Eastern Region.

Job Responsibilities:

1. Responsibility over all Health Spring Eastern Region MA contracting decisions and outcomes- including managing terminations, adequacy, affordability for 33 states and national partnerships.

2. Accountable for the development, negotiation and successful completion of reimbursement contracts. Ensure appropriate coverage of networks for locations.

3. Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.

4. Develop strategies, draft agreements and negotiate contracts for newly recognized categories of providers.

5. Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed.

6. Oversee the performance of hospital audits and appropriate reimbursement of hospital costs.

7. Accountable for resolution of issues and contractual disputes.

8. Ensure staff meets/exceeds goals, objectives and initiatives. Ensure staff is trained, positions are filled, and employees receive communications on changes, etc.

9. Accountable for budget, operational reporting and financial reporting.

10. Communicate and interact effectively and professionally with co-workers, management, customers, etc.

JOB REQUIREMENTS:

• Bachelor degree and 6 years experience in health care/insurance administration, hospital/health care contracting, and hospital/physician relations OR 8 years experience in health care/insurance administration, hospital/health care contracting, and hospital/physician relations.

• 5 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.

*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

PREFERRED JOB REQUIREMENTS:

• MBA or Masters in Health Administration.

This is a Telecommute (Remote) role. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii or New York. Sponsorship is not available.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$161,500.00 - $299,700.00

Exact compensation may vary based on skills, experience, and location.

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For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.

Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

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