Job SummaryThis position is responsible for supporting HEDIS, STARS and financial provider performance and contracting activities to ensure strategic provider coverage within an assigned territory, including contract negotiations for physicians, physician groups, and small to mid-size hospitals, while providing support for more complex hospital and physician contracting initiatives. The role develops and maintains strong provider relationships, delivers ongoing provider education and service, and serves as a trusted partner to drive HEDIS, STARS, risk adjustment, and value-based care performance. Success in this role requires a consultative, data-driven professional who can engage providers, identify performance improvement opportunities, develop and execute action plans, leverage analytics to influence outcomes, and adapt strategies to achieve client goals in a rapidly evolving healthcare environment. Ability and willingness to travel within the assigned territory, including overnight stays, is required.
Required Job Qualifications: - Bachelor Degree and at least one year experience developing and negotiating provider contracts OR 5 years managed care operations experience handling independent work with at least one year experience developing and negotiating provider contracts.
- Meet deadlines and work well under pressure.
- Verbal and written communication skills, organizational and planning skills.
- PC proficiency to include Microsoft Office.
- Analytical skills.
- Ability and willingness to travel within assigned territory, including overnight stays
Preferred Job Qualifications: - Bachelor Degree in Business.
- 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.
- Experience with EMRs and population health tools, including provider outreach to facilitate access, retrieval of medical records and chart notes, and compliant handling of Protected Health Information (PHI) in accordance with HIPAA requirements.
ADDITIONAL DETAILS:- Client-site Location: This is a field based position in the Houston market. The individual will be onsite at provider offices up to 3 days a week and work from home typically 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$55,900.00 - $123,500.00
Exact compensation may vary based on skills, experience, and location.
