Director of Provider Contracting
Job Posting for Director of Provider Contracting at Commonwealth Care Alliance
- Lead the development and maintenance of the CCA hospital and physician network through the management of the hospital and physician contracting team, oversight of contract negotiations, and provider relationship development
- Provide strong leadership and management to staff of contract managers and contract specialists, including the development and maintenance of work flows, processes, performance metrics, and management tools to foster an environment of professionalism and performance excellence
- Develop and execute contracting strategies for hospital, health system, and physician contracts that support the clinical, programmatic, and financial goals of the organization
- Work with leadership and contracting team to strategize and prioritize provider recruitment and re-contracting activities in compliance with regulatory and corporate requirements
- Oversee and directly lead the pursuit, negotiation, analysis, and implementation of fee-for-service and performance and risk-based health system and primary care agreements
- Effectively and professionally represent CCA with providers and provider organizations
- Manage contract implementation function, including staff, work processes, and quality assurance initiatives necessary to accurately configure, implement, and carry out financial and non-financial contract terms
- Maintain positive working relationships with contracted providers, systems, and institutions
- Identify synergy between CCA and potential new providers, and effectively implement and maintain these new provider relationships
- Demonstrate a solid understanding of Medicare and Medicaid reimbursement methodologies.
- Bachelor's Degree or equivalent experience
- Masters Preferred in Business, Public Health, Public Policy, or related field
- Minimum seven years of experience in health care, with minimum five years in provider contracting
- Experience with leadership in provider contracting and health care reimbursement
- Must have supervisory experience and demonstrated ability to work with staff to achieve goals
- Experience with hospital, physician, and performance-based primary care and health system contracting required
- Knowledge and experience of provider contracting, contract terms, and health care reimbursement
- Knowledge of Medicaid and Medicare programs and reimbursement methodologies
- Knowledge of a range of provider types, including professional, ancillary, long term care, and community-based providers
- Demonstrated abilities in staff supervision, motivation, and management.
- Ability to work cross functionally to set priorities, build partnerships, meet internal customer needs, and obtain support for department initiatives
- Ability to plan, organize, and manage own work and that of direct reports; set priorities and measure performance against established benchmarks
- Ability to identify, develop, track, and measure key performance metrics
- Ability to communicate and work effectively at multiple levels within the company
- Customer service orientation; positive outlook, self-motivated and able to motivate others
- Strong work ethic; able to solve problems and overcome challenges
- Collaborates with and builds strong partnerships across the organization to align network recruitment and management activities with membership and clinical care goals, regulatory compliance, and other organizational priorities.
- Possess a solid understanding of Medicare and Medicaid reimbursement methodologies.
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Salary.com Estimation for Director of Provider Contracting in Cerritos, CA
$109,118 to $147,352
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