Director Network Contract Coord

Company: Seaboard Solutions
Location: Houston
Posted on: March 21, 2025

Job Description:

Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our PulsePoint locations.Position Overview: The Director Network Contract Coordinator is responsible for managing and negotiating contracts with large home health (HH), durable medical equipment (DME), large vendors, and aggregators to ensure a home health agency can provide services to patients while maintaining financial viability. Key duties include identifying the best contract payment model, negotiating contract terms, monitoring compliance with contract agreements, and minimizing year-over-year unit costs for Carelon Medical Benefits Management businesses.How You Will Make an Impact:

• Lead contract negotiations with home health (HH), durable medical equipment (DME), and other ancillary providers and vendors, including negotiating reimbursement rates, service offerings, utilization management, and quality metrics.
• Develop and maintain strong relationships with key decision-makers at payer organizations to understand their needs and advocate effectively for the agency's interests.
• Analyze contract terms to assess financial implications, identify potential risks, and ensure compliance with regulatory requirements.
• Stay updated on industry trends, payer regulations, and market dynamics to identify new contracting opportunities.
• Develop financial projections and forecasts based on potential contract agreements to evaluate their impact on the agency's revenue and profitability.
• Regularly monitor contract performance, including utilization rates, reimbursement levels, and adherence to contract terms.
• Collaborate with clinical teams to identify areas for quality improvement related to contract requirements and patient care.
• Lead and mentor a team of contract specialists responsible for managing specific payer relationships and contracts.
• Direct the contract administration policies and standards, providing strategic oversight of the contract administration function.
• Identify contract administration information needs and technologies and manage the annual operating budget within financial objectives.
• Hire, train, coach, counsel, and evaluate the performance of direct reports.
• Provide quality control services through monitoring work results and performing audits.
• Develop and implement associate training and prepare reports to support the organization's objectives.
• May be assigned to special project work consistent with the role and dictated by business needs.Minimum Requirements: Requires a Bachelor's degree in a related field and a minimum of 5 years of equivalent work experience in provider contracting, or any combination of education/experience that would provide an equivalent background.Preferred Skills, Capabilities, and Experience:
• Over 5 years of experience in healthcare contracting, with direct expertise in negotiating contracts with large home health (HH) and durable medical equipment (DME) providers.
• Proven track record of successfully negotiating and managing provider contracts, with a comprehensive understanding of the home health and DME industry.
• Deep knowledge of Medicare, Medicaid, and Commercial business practices related to home health, DME, and other post-acute services.
• Strong analytical skills for interpreting financial data and making informed decisions regarding contract profitability.
• Exceptional strategic thinking, decision-making, and problem-solving skills.
• Experience in collaborating with cross-functional teams and coordinating efforts towards common goals.
• Excellent written, oral, presentation, and interpersonal communication skills.
• Experience using CONGA contracting tools is preferred.
• Proficiency in Microsoft Office products, particularly in PowerPoint and Excel.Salary: For candidates working in person or remotely in the below location(s), the salary range for this specific position is $130,452 to $223,632. Locations: District of Columbia (Washington, DC); Illinois; Maryland; Minnesota; New York.In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).
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Keywords: Seaboard Solutions, Houston , Director Network Contract Coord, Executive , Houston, Texas