Health Care Service Corporation · 6 hours ago
Principal Network Management Consultant
Chicago, IL
Full-time
Hybrid
Senior Level, Lead/Staff
$93K/yr - $168K/yr
4+ years expHealth Care Service Corporation (HCSC) is a purpose-driven company that invests in the professional development of its employees. The Principal Network Management Consultant will be responsible for provider recruitment and contracting, developing and negotiating contracts, and maintaining relationships with providers to ensure strategic coverage for the assigned territory.
Health InsuranceInsurance
Responsibilities
Work with internal departments to ensure appropriate implementation of executed agreements
Analyze financial reports to determine financial impact of negotiations
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
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
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
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
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
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
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
Explain corporate policies and procedures to contracted providers; counsel with provider’s staff to ensure their familiarity with Blue Cross procedures
Establish and maintain relationships with assigned providers through personal visits, correspondence and telephone calls
Serve as a mentor/teacher regarding the activities of staff
Serve on local and corporate committees and task forces that require input from Network Management Department. Participate in trade association meetings, as required
Transform fee for service contracts to fee for value
Develop reports and analyze performance outcomes
Ensure all expenditures comply with corporate and divisional expense guidelines
Communicate and interact effectively and professionally with co-workers, management, customers, etc
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies
Maintain complete confidentiality of company business
Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested
Qualification
Required
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
Company
Health Care Service Corporation
Health Care Service Corporation is a customer-owned health insurance company.
10001+ employees
H1B Sponsorship
Health Care Service Corporation has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (198)
2024 (166)
2023 (132)
2022 (145)
2021 (73)
2020 (59)
Funding
Current Stage
Late StageLeadership Team
Manika Turnbull
Senior Vice President & Chief Human Resources Officer
Recent News
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