Description
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.
This position is responsible for developing and implementing the methodology which results in competitive contract pricing while maintaining a broad network of hospitals, physicians, behavioral health and ancillary providers on a statewide basis. Directing and overseeing management and staff responsible for contracting, provider relations activities, network directories, provider/facility database and reporting. This position collaborates with HCSC Network Management colleagues in the development of Enterprise Network strategies and initiatives.JOB DESCRIPTION:
Direct and manage a staff of management, professional and support personnel responsible for contracting, data base and reporting who are engaged in the recruiting, contracting, educating and maintenance of a cost effective statewide network of facilities and providers. Plan, organize and coordinate the implementation of programs and activities designed to sustain and improve our working relationship with facilities/providers and to enhance HCSC's image in the community.
Assist in the development of facility and provider strategies, direct the implementation of strategies and initiatives, and ensure attainment of goals.
Oversee maintenance of broad statewide managed care networks.
Directly handle or “close” contracts on special or large contracts. Maintain direct strong working relationships with key providers, groups and community leaders. This is critical because this position is directly involved in the most difficult and large key facility/provider negotiations.
Develop plans and recommend the solutions for dealing with issues with significant impact on the business to Senior Leadership. Ensure communication to Sales and Actuarial of the impact of the changes in the network or the impact of projected fee schedules.
Work closely with Sales and the Data Analysis and Reporting team to assess the competitive position of the networks. This includes evaluating both the accessibility of providers and the discount levels in order to ensure the network meets our customer's needs. Analyze provider satisfaction survey results and formulate resolutions for problem trends which will aid in the maintenance of existing groups and the acquisition of new groups.
Maintain and further develop cooperative working relationship with other HCSC areas such as SSD, ITG, Credentialing and EHCM to ensure successful coordination of provider related activities within established timeframes. Promotes and facilitates expanding the use of existing technology to enhance the efficiency and effectiveness of business conducted between BCBS - Plan Division and facilities/providers.
Responsible for leadership of the facility and provider network groups. People management responsibilities include but are not limited to performance management, pay administration, professional development, diversity, change management, and development and maintenance of budget.
Develop and monitor an effective communication/training program to keep contracting representatives apprised of new/additional servicing responsibilities in conjunction with other members of division management. Oversee provider/facility education and servicing including orientations, service calls and the production of education materials, and training of internal staff and other internal departments.
Responsible for Quality Improvement Programs to ensure all facility/provider agreements, policies and processes comply with state regulations, corporate standards, legislative mandates and accreditation/federal guidelines.
Oversees the development and production of communication materials for facilities/providers and facility/provider directories.
Participate with financial strategy committee in the assessment of network results as related to cost and utilization.
Responsible for department responding to facility/provider inquiries in an effective and timely manner and work with other departments/teams to resolve claims processing and claims payment problems.
Analyze monthly activity reports, budget and variance reports and formulate resolutions for problem trends.
Responsible for meeting with largest accounts periodically to hear their perspectives, respond to their issues and to exchange ideas concerning the provider network. This also includes communicating with the large accounts to let them know about network changes, issues, etc.
Responsible for Request for Proposals, BCBSA surveys, and national inquiries regarding network status. This includes meeting with the largest potential accounts in Best and Final presentations to present the strengths of our network and answer their questions.
May lead committees or participate in internal and external committees.
Communicate and interact effectively and professionally with co-workers, management, customers, etc.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Maintain complete confidentiality of company business.
Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
Bachelor Degree and 10 years health care or health insurance experience to include 4 years contract administration and facility or provider relations experience OR 14 years of health care or health insurance experience to include 4 years contract administration and facility or provider relations experience.
4 years management experience including hiring, performance management, change management and professional development.
Leadership skills.
Financial acumen, experience with oversight of budget, and experience with financial managed care contracting.
Knowledge of facility/provider contracting methodologies and pricing strategies and the facility or provider community.
Presentation skills.
Negotiation, contracting skills and analytical and strategic thinking skills.
Verbal and written communication skills.
PREFERRED JOB REQUIREMENTS:
Masters Degree.
Experience developing strategies and implementing initiatives.
Experience developing budget.
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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.
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