Principal Network Management Consultant

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

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Job Summary

This position is hybrid (3 days a week in the office)
This Position Is Responsible For Provider Recruitment And Contracting Of Physicians, Physician Groups And Facilities Including Large Or Complex Groups/Facilities (Large Independent Hospital Systems, Integrated & Non-Integrated Systems, Value Based Contracting, Etc). Develop And Negotiate Contracts. Develop And Maintain Relationships With Providers. Ensure Strategic Coverage For Assigned Territory. Responsible For Education Of Providers And For Ongoing Provider Service. Provide Subject Matter Expertise To Improve Efficiencies And Results.
Job Description
1.Work with internal departments to ensure appropriate implementation of executed agreements.2.Analyze financial reports to determine financial impact of negotiations.3.Develop and negotiate agreements with providers and facilities (including large independent hospital systems, integrated & non-integrated systems, value based contracting, etc.) within assigned territory of responsibility. 4.Responsible for maintaining a professional relationship with key provider groups. Ensure effective liaison and rapport is developed and maintained through meetings, correspondence and telephone calls.5.Ensure strategic objectives are being met with regard to physicians, physician groups and facilities needed for assigned territory(s). Ensure appropriate provider services including working across departments to resolve issues. 6.Oversee the servicing of facilities, large groups, and/or capitated entities to include assisting with eligibility and capitation issues, contracting issues, and bonus arrangements. Serves as a liaison between internal departments and the capitated entity.7.Work with delegated entities to ensure that providers are loaded correctly. Work closely with the delegation oversight department regarding the delegated entity reporting requirements to include claims delegation, utilization management delegation and credentialing delegation.8.Respond to provider inquiries in an effective and timely manner and assist in claims resolution and payment problems. Must work closely with the Pricing, Full Service Units, Utilization Management, Medical, Delegation Oversight, Core Credentialing, Provider Automation and other divisions within the company.9.Provide leadership regarding negotiation of rates for traditional and managed care business. Conduct and assist in the negotiation process and assure that providers are kept informed of pertinent changes in policies and procedures. Coordinate appropriate education/in-servicing is provided for providers. Education may pertain to managed care and areas where pertinent rulings/regulations could affect business.10.Explain corporate policies and procedures to contracted providers; counsel with provider’s staff to ensure their familiarity with Blue Cross procedures.11.Establish and maintain relationships with assigned providers through personal visits, correspondence and telephone calls.12.Serve as a mentor/teacher regarding the activities of staff.13.Serve on local and corporate committees and task forces that require input from Network Management Department. Participate in trade association meetings, as required. 14.Transform fee for service contracts to fee for value.15.Develop reports and analyze performance outcomes. 16.Ensure all expenditures comply with corporate and divisional expense guidelines.17.Communicate and interact effectively and professionally with co-workers, management, customers, etc.18.Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.19.Maintain complete confidentiality of company business.20.Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS: *Bachelor Degree and 4 years provider contracting experience OR Master degree and 3 years contracting experience OR 8 years business experience including 4 years provider contracting experience. Contracting experience involves negotiating reimbursements, financial arrangements and rates. *Extensive knowledge of provider and facility contracting, products, and claims/processing systems. *Negotiation skills. *Relationship building skills. *Knowledge of marketplace. *Meet deadlines and work well under pressure. *Verbal and written communication skills to interact with all levels of corporate personnel and providers. *PC proficiency to include Microsoft Office. *Analytical skills and business acumen to analyze financial data to determine financial impact of negotiations. *Ability and willingness to travel within assigned areas of responsibility, including overnight stays.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$90,900.00 - $164,200.00

Exact compensation may vary based on skills, experience, and location.