Executive Director, Provider Contracting- HealthSpring Eastern Region

Provider Relations Manager

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.

Job Summary

This position is responsible for overall provider relations 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

HCSC Employment Statement

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.

Base Pay Range

$158,300.00 - $293,800.00. Exact compensation may vary based on skills, experience, and location.