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Senior Provider Contracting Consultant

Highmark Inc.

  • Company Highmark
  • Wilkes-Barre, PA
  • Procurement
  • Full time
  • Day (United States of America)

Company :

Highmark Inc.

Job Description : 

General Overview:

This job serves as the primary contact for hospital negotiations.  The incumbent is responsible for completion of annual provider contracting activities and ongoing contract management activities. Works regularly with senior leadership both within Highmark and with the provider on negotiations and other initiatives directed at building strategic relationships in alignment with our Living Health strategy.  This role is primarily focused externally (negotiations, etc.) but also acts a subject matter expert (SME) for internal projects, etc. 

Essential Job Functions:

  • Lead negotiation of assigned mid-sized and large hospitals and health systems reimbursement and contractual terms.  Represent Highmark external during such negotiations, with additional support as needed.  Development and execution of work plans and strategy for assigned provider contracts. 

  • Execute Highmark provider contracting strategy related to hospital reimbursement and contracting.  This includes contract standardization, internal cost savings efforts, and ongoing attention to unit cost trends. 

  • Primary Highmark contact, and/or relationship owner for assigned hospitals.  Support Director, Vice President, and other members of senior leadership for any activities related to assigned hospital providers. 

  • Responsible for end-to-end provider contract administration and maintenance for assigned hospital providers.  Work with internal team members and other areas of Highmark to effectively negotiate and implement provider agreements. 

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

  • Support Provider Contracting departmental activities and initiatives including process improvement efforts as needed. 

  • Other duties as assigned.

Minimum Qualifications:

  • Bachelor's Degree ( Substitution  - 6 years of healthcare experience in lieu of a bachelor's degree)

  • 5 years in the Health Insurance industry

  • 1 years with Provider Contract Negotiations

Preferred Qualifications:

  • Master's Degree

Knowledge, Skills, and Abilities:

  • Negotiation

  • Contract Management

  • Contracts Review

  • Written & Oral Presentation Skills

  • Problem Solving & Decision Making

  • Provider Contracts

  • Leadership

Referral Bonus: Level 1

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 ( )

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