Director, Contracting

» Director, Contracting
Legal
in Harrisburg
, PA
Reference: 19-03300

Description:

Coordinate, negotiate and handle activities of the provider contracting, network development and/or provider relations functions and aid in formulating and administering organizational policies and procedures. Negotiate large hospital, physician groups and ancillary service agreements in accordance with corporate, health plan and government regulations and guidelines.

Responsibilities:

  • Oversee provider contracting activities to ensure efficiency and maintain compliance with company policies and standards and government laws and regulations
  • Negotiate contracts with hospitals, physician groups and ancillary service agreements
  • Develop and implement a network development plan for the assigned region and set of providers and identify and initiate contact with potential providers in support of the company’s strategic goals and objectives
  • Effectively integrate new programs and strategies to reach per member per month targets, and provide oversight to the provider
  • Set up and contract configuration in the computer system to ensure accurate claims adjudication
  • Perform basic financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives
  • Evaluate and monitor providers’ performance standards and financial performance of contracts

Education/Experience:

  • Bachelor’s degree in Business Administration, Healthcare Administration, related field or equivalent experience
  • 5+ years of related experience negotiating hospital, large physician groups and ancillary service agreements and external customer service for providers
  • Experience in marketing/sales, medical economics in a managed care or insurance environment
  • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff
  • Experience in provider network management, Medicaid/Medicare contracting, and/or claims processing preferred

License/Certification:

  • Valid driver’s license