Director Provider Contracting

Apply for Director Provider Contracting | Careers at Highmark Health Skip to main content Careers Working here Our Companies Career Areas Early CareersInterns Talent Community Team Member Stories Veterans Explore Jobs Provider ServicesDirector Provider Contracting Explore our jobs Director Provider Contracting Apply Open in new tab iconPA - Camp HillHarrisburg & Surrounding AreasCompany Highmark Inc.Job Description JOB SUMMARYThis job is responsible for directing negotiation of the plans key contracts with health care providers hospitals PHOs physicians intermediate care providers. Directs financial analyses of the providers payment history develops approaches to manage the payout consistent with company parameters oversees the actual negotiation process and assumes the lead where necessary. Responsible for the development implementation maintenance and updating of the plans multiple fee schedules and payment methodologies used to reimburse institutional and professional providers. Implements network contract and reimbursement initiatives as indicated by enterprise and market strategy.ESSENTIAL RESPONSIBILITIESDirectand overseehospital and institutional provider contract negotiations taking the lead in complex or high-dollar situations where appropriate.Negotiaterates for nonparticipating provider services or non-contracted services for applicable products.Coordinatefinancial analyses and development of strategies for contract negotiations.Manage the design and implementation of provider strategies and reimbursement methodologies aimed at controlling health care costs and evaluate the impact on providers.Develop strategic relationships with key provider constituents and maintain critical communication with institutional and professional providers in sensitive contract discussions or in resolving reimbursement issues.Generally coordinates and has primary responsibility for all provider reimbursement activities within the Plan including the execution of initiatives in support of enterprise and market strategy.Engagewith external consultants as needed to develop and evaluate recommendations related to reimbursement and contract compliance or other reimbursement-related issues.May prepare expansion requests for regulatory agencies oversee the production of provider directories for members providers and community agencies has responsibility for the provider application process and oversee production of and reviews Access & Availability studies and GeoAccess maps Alternative Language Studies and Encounter Studies for all states and all lines of business.Facilitateand overseeCACTUS credentialing database functionality and paperless workflow processes through OnBase document management system.Other duties as assigned or requested.EDUCATIONRequiredBachelors degree in business finance information management healthcare administration or health related discipline or relevant experience andor education as determined by the company in lieu of bachelors degreePreferredMasters degree in Business or Health Care AdministrationEXPERIENCERequired5 years of experience in health care administrationdeliveryfinance or a related field3 years of experience in a management rolePreferredNoneLICENSES or CERTIFICATIONSRequiredNonePreferredCPASkillsPreferred working knowledge of third-party payment concepts and a solid understanding of health care finance and regional market environmentDemonstrated ability to act as a spokesman and interface with external corporate officers and consultants in contract negotiationsSuperior ability to analyze data and reimbursement methods to determine strategies and issue resolution in negotiations and other business mattersSCOPE OF RESPONSIBILITY Does this role supervisemanage other employeesYesWORK ENVIRONMENTIs Travel RequiredYesDisclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties responsibilities and qualifications required of employees to do this job.Compliance Requirement This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policiesAs a component of job responsibilities employees may have access to covered information cardholder data or other confidential customer information that must be protected at all times. In connection with this all employees must comply with both the Health Insurance Portability Accountability Act of 1996 HIPAA as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Companys Handbook of Privacy Policies and Practices and Information Security Policy.Furthermore it is every employees responsibility to comply with the companys Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws rules and regulations as well as company policies and training requirements.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal state or local law.We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process please contact the email below.For accommodation requests please contact HR Services Online at HRServiceshighmarkhealth.orgCalifornia Consumer Privacy Act Employees Contractors and Applicants Notice Apply Job DetailsJob categoryProvider ServicesPosition TypeFull TimePosted2025-12-18T002603.2858080000LocationsPA - Camp HillHarrisburg & Surrounding AreasLine of BusinessEntityRecruiterHiring ManagerExperience LevelReq IDJ273517 Share Facebook X LinkedIn Whatsapp Email Copy URL Apply Open in new tab iconArrow left iconTwitter iconFacebook iconLinkedin iconInstagram iconYoutube iconGlassdoor icon Featured Links Competitively Sensitive Information Cyber Security Notice at Collection E-Verify English E-Verify - Employee Rights and Responsibilities Data Protection Sitemap Terms of Service Do Not SellShare E-Verify Spanish Digital Privacy Policy Highmark Health is an independent licensee of the Blue Cross Blue Shield Association. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal state or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process please contact the email below. For accommodation requests please contact HR Services Online at HRServiceshighmarkhealth.org. © 2025 Highmark Health. All Rights Reserved.