Resp & Qualifications
PURPOSE:
This role is responsible for the financial negotiations of all Hospital contracts including but not limited to those in Value-Based contracts representing more than $2 billion in cost of care. This role is critical to driving the effort to transition from a fee-for-service payment system which incents health care providers to generate volume to a payment approach that rewards providers for the value they create.
ESSENTIAL FUNCTIONS:
- Lead Hospital financial negotiator managing the relationship with the payment transformation team to ensure a thoughtful, innovative, measurable and enforceable contract terms with the health system to drive provider performance and transformation.
- Present new contracts to review contract and reimbursement terms and work with executive leadership of practices and health systems through the implementation phase of these new value-based and individual hospital arrangements. Responsible to develop and gain approval from executive management for an annual negotiation strategy.
- Develop, negotiate, and maintain the complex reimbursement methodologies to support the reimbursement terms which are the basis for the payment of claims for all hospital services including those in value based arrangements. This position will serve as department SME interacting with the Regulatory Affairs Director for Health Services Cost Review Commission (HSCRC) policies and activities to appropriately evaluate impact of value-based contracts in Maryland?s regulated environment.
- Interface and coordinate efforts with the Networks and Contract Management teams. This position is responsible for overseeing and ensuring all critical elements of the financial terms of the Hospital contracts are tracked, properly reviewed and implemented each year.
- This position will be directly responsible for research related to competitiveness of contract terms and rates, alternative payment models, accountable care organizations, clinically integrated networks and other research needs of the department. Coordinate and ensure all performance guarantees are approved and tracked for Provider Contracting and Reimbursement.
- Responsible for quarterly metrics reporting related to contract reimbursement (contracting & pricing) that gets produced for the executive team.
- Responsible for management and oversight of relationship with any additional consultants/vendors that may contract with for competitive analysis, etc.; direction and vision for policy and quality standards for all hospital rate negotiations ,and track schedule to assure all hospital reimbursement negations occur timely and all finical terms are maintained in accordance with the contract.
SUPERVISORY RESPONSIBILITY:
This position has no direct reports, however, may informally lead teams in a matrix environment.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business, Healthcare, Finance or related field OR in lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience.
Experience: 10 years experience in health care insurance industry with specific experience in contracting, negotiation and reimbursement development.
Preferred Qualifications: Analytical skills principles as evidenced by CPA or MBA highly desirable.
Knowledge, Skills and Abilities (KSAs)
- Deep knowledge of value-based programs and contract structure.
- Ability to present professionally to senior leadership internally and externally.
- Effective negotiation skills and service oriented.
Salary Range: $114,960 - $205,491
Travel Requirements:
Estimate Amount: 30% Local travel to attend meetings onsite with provider groups and regulators.
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
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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