Welcome! To apply, please sign in using your existing account or create a new one. You may also continue without an account.
New User
Returning User
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)
