Director, Provider Network Contracting
About The Position
The Director of Provider Network Contracting is responsible for maintaining and growing a comprehensive network of affiliated healthcare providers across the Sanford Health Plan footprint, identifying specialties and geographic locations on which to concentrate resources to ensure compliance with applicable state/federal access requirements. The Director will negotiate reimbursement terms that are built on Sanford Health Plan contract and payment standards and assist in development of advanced payment models to serve the health care needs of Sanford Health Plan membership. Oversees development and execution of provider contracting strategies. Identifies and creates processes to establish links between Contracting and other Plan departments regarding contract requirements. Engages in the development of new reimbursement models jointly with Analytics, IT, Claims, Finance and Medical Services. Communicates new strategies to applicable stakeholders for input, most importantly, key provider stakeholders. Helps implement strategies as needed to achieve desired goals and reduce member access grievances. Ownership the contracting lifecycle, ensuring timely execution and communication of the contract life cycle and revenue capture while actively advising the other Plan departments on decisions relating to contract business/financial terms, legal, and regulatory compliance issues, while having an intimate knowledge of contract terms and issues within their contract. Communicates network and contractual information for company business purposes. Oversees the maintenance of all Provider Contract Templates. Works with Legal, Corporate and applicable stakeholders, on an as needed basis, to modify contract templates to ensure compliance with the requirements of NCQA, Centers for Medicare and Medicaid Services and other applicable laws and regulations. Also oversees contract document management of templates and executed agreements. Oversees network adequacy to ensure compliance with state and federal access requirements.
Requirements
- Bachelor's degree is required with a concentration in healthcare or finance related field preferred.
- Must have seven years of relevant experience, superior communication and interpersonal skills.
- Specific background or experience in healthcare reimbursement and/or contract negotiations would be critical to success in this role.
Responsibilities
- Maintaining and growing a comprehensive network of affiliated healthcare providers across the Sanford Health Plan footprint
- Identifying specialties and geographic locations on which to concentrate resources to ensure compliance with applicable state/federal access requirements
- Negotiating reimbursement terms that are built on Sanford Health Plan contract and payment standards
- Assisting in development of advanced payment models to serve the health care needs of Sanford Health Plan membership
- Overseeing development and execution of provider contracting strategies
- Identifying and creating processes to establish links between Contracting and other Plan departments regarding contract requirements
- Engaging in the development of new reimbursement models jointly with Analytics, IT, Claims, Finance and Medical Services
- Communicating new strategies to applicable stakeholders for input, most importantly, key provider stakeholders
- Helping implement strategies as needed to achieve desired goals and reduce member access grievances
- Ownership the contracting lifecycle, ensuring timely execution and communication of the contract life cycle and revenue capture
- Actively advising the other Plan departments on decisions relating to contract business/financial terms, legal, and regulatory compliance issues
- Communicating network and contractual information for company business purposes
- Overseeing the maintenance of all Provider Contract Templates
- Working with Legal, Corporate and applicable stakeholders, on an as needed basis, to modify contract templates to ensure compliance with the requirements of NCQA, Centers for Medicare and Medicaid Services and other applicable laws and regulations
- Overseeing contract document management of templates and executed agreements
- Overseeing network adequacy to ensure compliance with state and federal access requirements
Benefits
- Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees.
- Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance.
- For more information about Total Rewards, visit https://sanfordcareers.com/benefits .
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What This Job Offers
Job Type
Full-time
Career Level
Director
Industry
Hospitals
Number of Employees
5,001-10,000 employees
