Provider Contracting Consultant - Highmark Health
Trenton, NJ
About the Job
Company :
Highmark Inc.
Job Description :
Job Description Summary
This position works within the Provider Contracting Development Operations Department and is responsible for facilitating the development and editing and interpretation of provider contract language.
Job Description
This position works within the Provider Contracting Development Operations Department and is responsible for facilitating the development and editing and interpretation of provider contract language. Accountable for all contracts including multi-market facility and ancillary agreements, as well as value-based contracts. Works with the Organization's internal legal department to develop recommended contracting strategies and interpret contract language and risk. Provides support to markets regarding any terminations including any required regulatory reporting.
ESSENTIAL RESPONSIBLITIES
+ Lead negotiations of assigned Ancillary and small hospital reimbursement and contractual terms. Development and execution of work plans and strategy for provider contracting initiatives.
+ Execute Highmark provider contracting strategy related to assigned ancillary reimbursement and contracting. Including standardization and unit cost trend.
+ Responsible for end-to-end provider contract administration and maintenance for assigned ancillary and hospital providers, supported by Sr. Provider Contract Analyst, etc.
+ Develop and maintain positive, effective relationships with assigned providers.
+ Support the management and development of Provider Contract Analysts.
+ Ensure compliance with contractual terms.
+ Other duties as assigned.
EDUCATION
Required
+ Bachelor's Degree
Substitutions
+ 6 years of healthcare experience in lieu of a bachelor's degree
Preferred
+ None
Licenses or Certifications
+ None
Experience
Required
+ 5 - 7 years in the Healthcare Industry
+ 3-5 years in Provider Contracting
Skills
+ Ability to influence without having direct or indirect organizational control.
+ Ability to work independently and manage multiple projects/assignments/responsibilities in a fast-paced environment.
+ Communicates effectively.
+ Decision-making
+ Problem-solving and critical thinking skills with ability to identify issues, resolve them quickly.
+ Strong negotiation and customer relationship management skills
+ Resourceful, creative, and results-oriented thinker
+ Experience with federal and state regulatory requirements, regulatory compliance.
+ Project management/process improvement experience
+ Contract language and interpretation experience
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
_Disclaimer:_ _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
_Compliance Requirement_ _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
Pay Range Minimum:
$67,500.00
Pay Range Maximum:
$124,800.00
_Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
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, age, 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, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( _https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.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 contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J249963
Highmark Inc.
Job Description :
Job Description Summary
This position works within the Provider Contracting Development Operations Department and is responsible for facilitating the development and editing and interpretation of provider contract language.
Job Description
This position works within the Provider Contracting Development Operations Department and is responsible for facilitating the development and editing and interpretation of provider contract language. Accountable for all contracts including multi-market facility and ancillary agreements, as well as value-based contracts. Works with the Organization's internal legal department to develop recommended contracting strategies and interpret contract language and risk. Provides support to markets regarding any terminations including any required regulatory reporting.
ESSENTIAL RESPONSIBLITIES
+ Lead negotiations of assigned Ancillary and small hospital reimbursement and contractual terms. Development and execution of work plans and strategy for provider contracting initiatives.
+ Execute Highmark provider contracting strategy related to assigned ancillary reimbursement and contracting. Including standardization and unit cost trend.
+ Responsible for end-to-end provider contract administration and maintenance for assigned ancillary and hospital providers, supported by Sr. Provider Contract Analyst, etc.
+ Develop and maintain positive, effective relationships with assigned providers.
+ Support the management and development of Provider Contract Analysts.
+ Ensure compliance with contractual terms.
+ Other duties as assigned.
EDUCATION
Required
+ Bachelor's Degree
Substitutions
+ 6 years of healthcare experience in lieu of a bachelor's degree
Preferred
+ None
Licenses or Certifications
+ None
Experience
Required
+ 5 - 7 years in the Healthcare Industry
+ 3-5 years in Provider Contracting
Skills
+ Ability to influence without having direct or indirect organizational control.
+ Ability to work independently and manage multiple projects/assignments/responsibilities in a fast-paced environment.
+ Communicates effectively.
+ Decision-making
+ Problem-solving and critical thinking skills with ability to identify issues, resolve them quickly.
+ Strong negotiation and customer relationship management skills
+ Resourceful, creative, and results-oriented thinker
+ Experience with federal and state regulatory requirements, regulatory compliance.
+ Project management/process improvement experience
+ Contract language and interpretation experience
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
_Disclaimer:_ _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
_Compliance Requirement_ _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
Pay Range Minimum:
$67,500.00
Pay Range Maximum:
$124,800.00
_Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
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, age, 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, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( _https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.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 contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J249963
Source : Highmark Health