Director, Provider Contracting

📋 Description

• Cultivate, sustain, and enhance strategic partnerships across various regions with hospitals, physicians, and ancillary and behavioral health providers.

• Oversee, negotiate, and finalize contracts with diverse provider types while ensuring effective implementation.

• Identify, create, and execute corporate contracting strategies along with business opportunities.

• Foster and uphold robust working relationships with key hospitals and network providers.

• Handle intricate contracting processes and negotiations for fee-for-service and value-based reimbursement models.

• Conduct independent analyses and collaborate with the Finance Division to assess the financial performance and healthcare costs associated with provider contracts.

• Spearhead complex contract implementations and proactively identify and resolve contractual issues.

• Design and manage value-based contracting incentives and reimbursement methods that prioritize quality and performance.

• Take the lead in addressing elevated and complex contractual issues with both internal and external clients.

• Engage in external provider meetings and internal operational discussions to enhance relationships, processes, operations, and best practices.

• Supervise the development of precise and timely internal communications regarding new and renewed managed care agreements.

• Develop, assess, and interpret contractual language to ensure alignment with company policies and relevant regulatory bodies.

• Oversee all revisions to contract templates, collaborating with Compliance and Legal to keep templates current.

• Create and manage all departmental and organizational resource materials pertinent to Provider Contracting.

• Accountable for training the contracting team on operational changes, departmental updates, and forthcoming projects.

⛳️ Requirements

• Bachelor's degree from an accredited four-year university or equivalent coursework or experience in the managed healthcare sector.

• Over 10 years of professional experience in managed healthcare administration.

• At least 5 years of experience in people management within healthcare or contracting-related roles.

• Experience in an Independent Practice Association (IPA) or managed care environment.

• Strong financial insight with the ability to analyze and interpret financial trends effectively.

• Demonstrated skills in contract preparation, with extensive knowledge of Medicare, Medi-Cal, PPO, HMO Commercial lines of business, various reimbursement methodologies, and value-based contracting.

🏝️ Benefits

• Comprehensive medical, vision, and dental insurance.

• 401k retirement savings plan with company matching contributions.

• Flexible time off along with 9 paid holidays.

• Annual bonus program.