At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
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 https://careers.hcsc.com/totalrewards
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.
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.
$161,500.00 - $299,700.00
Exact compensation may vary based on skills, experience, and location.
Health Care Service Corporation serves nearly 23 million people across the United States through its portfolio of health benefit solutions.
HCSC provides health coverage options for employers large and small, individuals and families, and Medicare and Medicaid plans. HCSC also offers related health care products and services such as pharmacy solutions, life and dental insurance, and health data technology. A Mutual Legal Reserve Company, HCSC is an independent licensee of the Blue Cross Blue Shield Association.
For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our future—driving innovations that further expand access, improve health outcomes, and reduce costs.
Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry.
As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible.
Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization: HCSC.com/careers. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to an inclusive, drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability, or protected veteran status.
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