Provider Contracting Director is responsible for the operations of the provider contracts department. Ensures that provider contracts are processed to support accurate and efficient claims payments. Being a Provider Contracting Director oversees the formulation of provider contracts and specific terms. Analyzes contract data and provides financial projections. Additionally, Provider Contracting Director requires a bachelor's degree. Typically reports to top management. The Provider Contracting Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Provider Contracting Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Resp & Qualifications
PURPOSE:
We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and at last two days a week at a CareFirst location based on business needs and work activities/deliverables that week.
This role is responsible for managing the ongoing adequacy and competitiveness of the CareFirst provider networks. The emphasis is on competitive market positioning and assuring our networks allow for the appropriate access to healthcare services in accordance with the CareFirst mission. This includes but is not limited to: formulation of contracting and reimbursement policy and strategy, negotiating legacy fee-for-service reimbursement terms, compliance with all network adequacy standards and contractual regulatory requirements, expanding the breadth and depth of CareFirst Value Based Agreements and implementation of new innovative networks and/or network innovation to support growth and expansion to new markets.
ESSENTIAL FUNCTIONS:
SUPERVISORY RESPONSIBILITY:
This position manages people.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business, Healthcare Administration, Finance, or related discipline OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience:
Preferred Qualifications:
Knowledge, Skills and Abilities (KSAs)
Salary Range: $136,000 - $252,450
Travel Requirements
Estimate Amount: 10%-day travel to provider offices within the CF service area on an as needed basis.
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Professional Contracting
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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