Director Provider Contracting Jobs in Silver Spring, MD

We are looking for a DIRECTOR OF PROVIDER CONTRACTING who can help shape our vision and support our mission. Here is what the position will look like.

Develop strategic direction and oversee the management and maintenance of department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.).

• Builds high performing teams with vision, leadership, goals and metrics. Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives. Provides awareness to staff how their work impacts other departments, programs and the enterprise. Encourages collaboration and holds team members accountable for achieving outstanding results.
• Responsible for all management functions including hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees; corrective action procedures and practices, addressing complaints and resolving problems. Develops and manages the department budget.
• Works closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
• Oversees/leads departmental projects and continuous improvement initiatives; may lead cross functional teams.
• Develops and implements department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.

• Oversees COA provider contracting function; responsible for leading the daily operations of the department and collaborating with other operational departments and functional business unit stakeholders to lead or support various provider contracting functions.
• Responsible for strategy development of a high performing network in consultation with Company executive management, legal counsel, medical management staff, and others.
• In collaboration with the IT department, supports and leads implementation of contracting software and client relationship management tools.
• Sets strategic direction for the contracting department that aligns with organizational goals and sets continuous improvement goals aligned with NCQA requirements, HCPF requirements, and DOI standards.
• Ability to successfully negotiate complex contracts with a variety of provider types, including but not limited to primary care, hospital systems and behavioral health providers.
• Ability to develop and implement efficient contracting processes, to create and refine contract amendment approval process, and effectively communicate changes to all relevant departments.
• Develops and modifies, in collaboration with Company legal counsel, standard provider contract templates for all major provider types, and oversees individual modifications as required for specific contracting negotiations.
• Collaborates closely with the Network Management Team to ensure network adequacy and network goals are met.
• Participates in Joint Operating Committee (JOCs) meetings with key providers and representatives from all aspects of corporate operations including claims, grievance and appeals, medical management, etc.
• Analyzes the financial results of current contract payment platforms and assesses the need and fiscal impact of altering the payment platforms.

Education: Bachelor’s degree in a relevant field is required. Equivalent combination of experience and/or education may substitute with a preference for seven years’ progressive relevant work experience. Business or related field; master’s degree preferred.

Experience: Minimum of 7 years health plan or health system provider contracting experience with 5 years of management experience required.

Knowledge, Skills, and Abilities: Extensive knowledge of health plan and/or health system contracting, provider reimbursement and claims payment, medical terminology, and health care delivery systems required. Good knowledge of local health and community agencies and providers preferred. Strategic business planning, change management, people management and project management skills required. Demonstrates support for the company’s mission, vision and values. Must have excellent negotiation skills and techniques and be up to date on negotiation strategies. Position requires excellent written and public speaking communication skills. Strong interpersonal, relationship building, and strategic partnership development skills with ability to deal with multiple levels of staff. Training, project development and management skills required. Strong attention to detail with excellent organizational and time management skills to multi-task and handle high volume workload. Proficient in Microsoft Office applications (Word, Excel, PowerPoint). May be required to manage multiple priorities and projects with tight deadlines.

Licenses/Certifications: A valid driver’s license and proof of current auto insurance will be required for any position requiring driving.

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

The compensation for this position is $150,700.00 – $185,600.00 annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status.

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

• Medical, dental, vision insurance that starts the first day of the month following start date.
• Supplemental insurance such as critical illness and accidental injury.
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility).
• Annual bonus program (based on eligibility, requirements and performance).

This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.