Healthcare Contracting Director

Remote with occasional travel (5-10%)
Existing relationships with Major Health Systems and Large Physician Groups across Florida
required. Background must include recent Payor / Major Health Plan Experience in Florida.
7 years of experience with health plans and provider organizations.

Duties And Responsibilities

• Manages contract negotiations with Major Health System and large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands
• Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations
• Proactively builds relationships that nurture provider partnerships to support the local market strategy
• Initiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing
• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position
• Identify and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreements
• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms
• Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.
• Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.
• Manages key provider relationships and is accountable for critical interface with providers and business staff
• Coach and support newer team members on strategies and approaches to successful negotiations
• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape
• Partner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity

Requirements

• Must have current Florida hospital contracting experience
• Bachelor’s degree or equivalent experience in related field, including 7 years of work experience beyond degree within provider contracting and/or health insurance
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
• Experience with complex Hospital / Health Systems, Large Physician Groups and Ancillary provider contracting and negotiations
• Experience negotiating delegated credentialing agreements
• Experience in developing and managing key provider relationships including senior executives
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
• Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
• Team player with proven ability to develop strong working relationships within a fast- paced organization
• The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
• Customer centric and interpersonal skills are required