Job Summary:

The Director, Provider Contracting executes contracting strategy, develops provisions based on cost, quality/analysis and monitors key metrics.

Essential Functions:

• Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting
• Ensure an ongoing high level of staff engagement, empowerment and development
• Responsible for provider recruitment, implementation of contracts
• Responsible of contracts and testing, initiating set-up, post configuration testing, maintenance and audit of claims system
• Create contract language and review with legal to develop approved contract templates
• Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
• Implement an efficient and effective process to on-board new providers; ensure network is adequate (access for members), cost-effective, competitive and stable, and meets corporate & regulatory requirements
• Responsible for ensuring all regulatory requirements for provider network are met
• Perform gap analysis to ensure no gaps and/or sanctions occur; identify & implement solutions that mitigate risk; development of corrective action plans as needed
• Responsible for access grievance intake, analysis and performance improvement initiatives
• Participate in training sessions for providers and staff as appropriate
• Support the contracting requirements of the corporation for geographic regions and products
• Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
• Assist with development and review of payment policies and provider notifications
• Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state
• Perform any other job related instruction as requested

Education and Experience:

• Bachelor’s degree in a healthcare related field, or equivalent work experience is required
• Master’s Degree or equivalent work experience is preferred
• Minimum three (3) years of contract negotiation experience is required
• Minimum three (3) years of management experience is required
• Managed care experience is highly preferred

Competencies, Knowledge and Skills:

$135,600.00 - $237,400.00SalaryBrand=