Executive Director, Provider Contracting

This is a fully remote position, open to applicants in Illinois, +3 more states.

📋 Description

• Manage overall provider relations

• Create and oversee network strategies for commercial HMO and PPO operations

• Draft, negotiate, and finalize reimbursement contracts

• Ensure adequate network coverage for various locations

• Develop networks and negotiate agreements for hospitals, professional groups, ancillary providers, and hospital-based physicians within Commercial HMO and PPO, Medicare Advantage, and Medicaid networks

• Attain competitive discounts and access via contract negotiations and relationship management

• Formulate strategies and negotiate contracts for newly recognized provider categories

• Supervise analysis and reporting for reimbursement strategies and implement corrective measures

• Oversee hospital audits and ensure appropriate reimbursement for hospital expenses

• Address issues and resolve contractual disputes

• Manage national contracting operations and oversee staff performance, training, staffing, and communication

• Administer budgets, operational reporting, and financial reporting

• Liaise with co-workers, management, clients, and external stakeholders

• Adhere to HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other relevant policies

• Maintain confidentiality regarding company business operations

• Update the Vice President of Network Management on developments and undertake special projects as assigned

• Travel as necessary

⛳️ Requirements

• Bachelor's degree and 15 years of experience in healthcare/insurance administration, hospital/healthcare contracting, and hospital/physician relations OR 19 years of experience in these fields

• 7 years of management experience

• Familiarity with hospital and provider reimbursement strategies and policies

• Strong verbal and written communication skills, including interpersonal skills

• Ability to represent the company to external stakeholders, negotiate contracts, resolve issues, and prepare presentations for executives and employees

• Leadership, teamwork, and relationship-building capabilities

• Experience in a fast-paced environment with the ability to meet deadlines

• Sound judgment and accuracy regarding financial matters such as contract performance and its impact

• Proficient negotiation skills

• Willingness and ability to travel

• Experience managing annual budgets and resource allocation

• Ability to translate needs and initiatives into effective business cases

• Capability to conduct cost-benefit analyses to justify investments and ensure ROI

• Sponsorship is not available

• Remote employees must reside within the continental United States, excluding Alaska, California, Hawaii, and New York

• MBA or Master's in Health Administration is preferred

• Experience in developing and executing national or multi-market contracting strategies is preferred

• Experience in negotiating value-based care and risk arrangements is preferred

🏝️ Benefits

• Curated development plans and opportunities for professional growth

• Annual incentive bonus program

• 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

• Additional incentives

• Remote work arrangement