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Provider Contracting Consultant
Company: Highmark Inc.
Job Description:
Job Description Summary: This position works within the Provider Contracting Development Operations Department and is responsible for facilitating the development, editing, and interpretation of provider contract language.
Essential Responsibilities:
- 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.
Education:
- Required: Bachelor's Degree
Substitutions:
- 6 years of healthcare experience in lieu of a bachelor's degree
Experience:
- 5 - 7 years in the Healthcare Industry
- 3-5 years in Provider Contracting
Skills:
- Ability to influence without having direct or indirect organizational control.
- Ability to work independently and manage multiple projects/assignments/responsibilities in a fast-paced environment.
- Communicates effectively.
- Decision-making.
- Problem-solving and critical thinking skills with ability to identify issues, resolve them quickly.
- Strong negotiation and customer relationship management skills.
- Resourceful, creative, and results-oriented thinker.
- Experience with federal and state regulatory requirements, regulatory compliance.
- Project management/process improvement experience.
- Contract language and interpretation experience.
Travel Requirement: 0% - 25%
Physical, Mental Demands and Working Conditions:
Position Type: Office-based
Disclaimer: This 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.
Pay Range: Minimum: $67,500.00; Maximum: $124,800.00
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.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity
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