Job Summary

This position is responsible for managing daily activities and implementing strategies to improve provider HEDIS, STARS, risk adjustment, and financial performance while leading provider recruitment and contracting efforts for physicians, physician groups, and facilities, including large or complex health systems and value-based arrangements. The role develops and negotiates contracts, builds and maintains strong provider relationships, ensures strategic coverage within the assigned territory, and provides ongoing provider education and service. Leading a team of Provider Performance Network Operations Consultants, this individual is responsible for the management, mentoring, and training of provider support resources while serving as a subject matter expert to improve efficiencies and results. Success in this role requires a consultative, data-driven leader who can engage physicians, influence behavior change, identify performance improvement opportunities, develop actionable plans, measure outcomes, and adjust strategies to achieve client goals in a value-based care environment

JOB REQUIREMENTS:

• Bachelor Degree and 5 years provider contracting experience OR 9 years managed care experience including 5 years provider contracting experience.
• Extensive knowledge of provider and facility contracting, products, and claims/processing systems.
• Leadership skills to oversee staff, implement initiatives, and work across the company to resolve issues.
• 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
• Project management skills to lead or participate in projects or initiatives.
• Ability and willingness to travel within assigned areas of responsibility, including overnight stays

PREFERRED REQUIREMENTS:

• Previous HEDIS and/or CMS STARs experience
• Solid understanding of health insurance, customer messaging/design and project management
• Expert level of Excel preferred (knowledge of pivot tables, VLOOKUP, etc.).
• Experience in financial/trend analysis
• Team player with proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results.

ADDITIONAL DETAILS:

• Client-site Location: This is a field based position in the Houston market. The individual will be onsite at provider offices typically 3 days a week and work from home 2 days a week.
• Schedule: Monday - Friday, typical business hours with infrequent evening and weekend meetings.
• Sponsorship: Sponsorship is not available

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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.

Base Pay Range
$92,700.00 - $167,500.00

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