Company :Highmark Inc.
Job Description :
This position works within the Provider Contracting department and is the primary contact for ancillary and small hospital negotiations. The incumbent is responsible for completion of annual provider contracting activities and ongoing contract management activities. Primarily focused externally (negotiations, etc.) this role also acts a SME for internal projects, etc. at the direction of their management.
- 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.
- Bachelor's Degree
- 6 years of healthcare experience in lieu of a bachelor's degree
Licenses or Certifications
- 5 - 7 years Health Insurance Industry
- 1 - 3 years Provider Contracting
- Contract Management
- Contracts Review
- Written & Oral Presentation Skills
- Problem Solving & Decision Making
Language (Other than English):
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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.
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
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