Director, Provider Contracting

5 hours ago

philadelphia, United States Jefferson Health Plans Full time

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.


We offer Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We’re also committed to boosting the health of our community through outreach, education, and events. Founded over 35 years ago, Jefferson Health Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care.


While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.


Perks of Jefferson Health Plans and why you will love it here:

  • Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
  • Flextime and Work-at-Home Options
  • Benefits & Wellness Program including generous Time Off
  • Impact on the communities we service

We are seeking a talented and enthusiastic Director, Provider Contracting to join our team


The Director of Provider Contracting is responsible for leading the contracting initiatives and strategies across HPP’s provider network. Additionally, the Director of Provider Contracting leads all end-to-end provider contract discussions for HPP’s hospital, physician, and ancillary networks.


As the Director, Provider Contracting, your daily duties may include:

  • Oversees and leads negotiations of fee-for-service, value-based and risk provider contracts.
  • Proposes and develops innovative contracting strategies for enhancing partnerships with network providers.
  • Manages day-to-day contractual relationship with HPP provider network.
  • Works with internal customers (e.g., provider reimbursement, configuration, and network account managers) to assist in resolving any issues arising from provider network.
  • Evaluates provider network gaps and proposes modifications to network..
  • Recruits, develops, motivates and retains a high caliber of team members.
  • Coaches and leads team to continuously improve operational performance.
  • Maintains and fosters a collaborative relationship with internal and external customers.
  • Manages budget and controls expenses while meeting operational, financial and service requirements.
  • Manages the accurate and timely implementation of all provider contracts, paying special attention to meeting NCQA, HEDIS, Federal, State, and other regulatory requirements.
  • Perform other duties as assigned.


Qualifications:

  • Bachelor’s Degree required
  • 5-10 years’ experience in managed care and provider contracting
  • Minimum of 3-5 years in a management (or equivalent level) position


Skills/Abilities:

  • Bachelor’s Degree required
  • Knowledge of managed care administration and standards, regulations and laws applicable to contracting.
  • Strong negotiation and conflict resolution skills required.
  • Knowledge and understanding of claims processing, member services, and provider services as they relate to provider contracting.
  • Experience in managing cross-functional projects and teams in claims, customer service, and/or provider affairs areas preferred.
  • Excellent organizational, interpersonal, time management and communications skills.
  • Process and project management ability.
  • Strong Microsoft Office skills

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