Job Details

Provider Contracting Director

Wisconsin | Executive Search


Job Description:
A health insurance company is seeking a Provider Contracting Director. The Provider Contracting Director will be responsible for implementing front-end contracting with providers and health systems, including the execution, negotiation and management of contracts. This is a relationship-based role that will have a high degree of visibility with providers in the marketplace. The director will deliver on the organization’s network and product expansion initiatives from a contracting perspective, including assessment of health system and provider partners, as well as membership utilization trends to garner the most favorable and compliant provider network structures. This is a retained search.

Responsibilities:

  • Conduct an annual effectiveness review of contracting strategies.
  • Ensure compliance with all contracting regulations and requirements.
  • Oversee provider recruitment and implementation of contracts.
  • Hold responsibility for contracts and testing, initiating setup, overseeing post-configuration testing, and maintaining and auditing the configuration within the claims system.
  • Establish and maintain contract templates with contract language.
  • Administer provider contracts, terms and reimbursement rates in a manner that complies with company policies and regulations.


Requirements:

  • 5+ years of provider contract negotiation experience in the health insurance industry
  • 5+ years of process leadership experience
  • Managed care experience (preferred)
  • Bachelor’s degree in a healthcare-related field or equivalent work experience; master’s degree or equivalent work experience (preferred)


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  • Job At-A-Glance


  • Category
    Network Development and Contracting,Executive

    Industry
    Health Plans

    Type
    Executive Search

    Location
    Wisconsin

    Reference ID
    35987