Director, Provider Contracting
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Job Description
Director of Provider Contracting at Altais developing and executing healthcare provider agreements. Leading negotiations, managing relationships, and implementing contracts across multiple provider types in the healthcare space.
Responsibilities:
- Develop, maintain and expand strategic relationships in multiple geographies with hospitals, physicians, ancillary and behavioral health providers
- Manage, negotiate and execute contracts with various provider types as well as implementation of such contracts
- Identify, develop, and implement corporate contracting strategies and business opportunities
- Develop and maintain strong working relationships with key hospitals and network providers
- Manage complex contracting and negotiations for fee for service and value-based reimbursements
- Perform analysis independently and coordinate with the Finance Division to review financial performance and healthcare costs of provider contracts
- Lead complex contract implementations and identify and resolve issues around contracts
- Create and manage value-based contracting incentives and reimbursement methodologies that are quality and performance based
- Lead in resolving elevated and complex contractual issues with internal and/or external customers
- Participate in external provider meetings and internal operational meetings to continuously improve relationships, processes, operations and best practices
- Oversee the development of accurate and timely internal communication around new and renewed managed care arrangements
- Develop, evaluate, and interpret contract language terms to ensure consistency with company policies and applicable regulatory agencies
- Oversee all contract template revisions, partnering with Compliance and Legal to ensure templates are up to date
- Create and oversee all departmental and organization resource material applicable to Provider Contracting
- Responsible for training contracting team on operational changes, department updates and upcoming projects
Requirements:
- Bachelor's degree from accredited 4-year university or equivalent coursework or equivalent experience in managed healthcare related field
- 10+ years professional managed healthcare administration experience
- 5+ years people management experience in healthcare / contracting related positions
- Experience working in IPA / managed care setting
- Strong financial acumen with proficiency in analyzing and interpreting financial trends
- Proven contract preparation skills, with in-depth knowledge of Medicare, Medi-Cal, PPO, HMO Commercial lines of business, various reimbursement methodologies and value-based contracting
Benefits:
- Excellent medical, vision, and dental coverage
- 401k savings plan with a company match
- Flexible time off and 9 Paid Holidays
- Annual bonus program
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