DescriptionThe Director, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Director, Provider Contracting requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
The Director, Provider Contracting is responsible for leading a team of provider contracting personnel responsible for the successful negotiation, execution, and implementation of Commercial, Medicare, and Medicaid contracts within the region. This includes communicating contract terms, payment structures, and reimbursement rates and analyzing financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.
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