Provider Contracting Consultant

Job ID: J124168
Company: Highmark BCBSD Inc.
Location: Wilmington, DE, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jun 12, 2018

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Description

GENERAL OVERVIEW:  

This section contains a synopsis of the main purpose(s) or functions(s) of the job, indicating what is done.This information will be used to develop the position posting.

Serve in a leadership role for all activities and develop strategies for contract negotiations that support departmental initiatives as well as Highmark’s corporate mission and objectives.  

ESSENTIAL RESPONSIBILITIES: 

This section lists the major duties and responsibilities of the position.This is not an exhaustive list of all job duties/functions/attributes.Depending on Role, essential responsibilities may also include oversight and management of people and functions described below.

1.Lead negotiations of provider payment and contractual terms, with responsibility for the development and execution of work plans and strategy for provider contracting initiatives.

2.Represent Provider Contracts for network provider contractual and/or reimbursement related concerns both internally and externally.

3.Mentor a team of Provider Contract Specialists in the development and assessment of pricing proposals and provider profile information for contract negotiations.

4.Develop and maintain positive, effective provider relationships. 

5.Support the management and development of Provider Contract Specialists.

6.Ensure compliance with contractual terms.

7.Other duties as assigned or requested.

III. QUALIFICATIONS:

Education, Licenses/Certifications, and Experience (For Experience requirements please see appropriate role/level guide.  If not applicable, list experience requirements below.)

Minimum

Describe in objective and non-comparative terms the minimum education level, previous experience, specific knowledge skills and abilities the individual must have to perform the job.

Preferred

  •  Bachelors Degree
  • 5-7  years of experience required in health care delivery system to include health insurance and managed care product administration.
  • 3-5 years of experience in provider contract negotiations.
  • Bachelors Degree in Business, Finance or Health Service Administration
  • MBA, MHA credentials

Knowledge, Skills and Abilities  (This section describes additional preferred characteristics)

  • Experience with Microsoft products with profiency with Excel and PowerPoint
  • Strong written communication skills
  • Strong interpersonal and presentation skills

IV. SCOPE OF RESPONSIBILITY  (People Management Responsibility)

Does this role supervise/manage other employees?          No  X     Yes   □      

If yes, indicate the number of direct reports: 

V. WORK ENVIRONMENT

Most company positions are performed in a normal office environment.   Please use this section to describe unusual work conditions, such as exposure to high noise levels, temperature extremes, etc.  If “none, “please indicate with “Not Applicable.”

Is Travel Required?

No   □

Yes X           

Unusual Working  Conditions

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job requires the ability to work as a team member.  Additionally, this job requires the willingness and ability to report to work on a regular and timely basis and may require irregular work hours, holidays and/or weekends.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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