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Job Summary

This role is responsible for managing a complex and high-volume caseload of Senate Bill 1264 (SB 1264) disputes involving out-of-network providers, with a defined book of business and elevated responsibility for case outcomes. The Senior Network Management Consultant leads negotiation strategy and resolution efforts for both informal and formal disputes, ensuring alignment with regulatory requirements, contractual standards, and statutory deadlines. This role requires advanced negotiation skills, strong analytical judgment, and the ability to independently manage complex, high-impact cases from intake through resolution. The Senior Consultant serves as a subject matter expert on reimbursement disputes and regulatory processes, providing guidance on case strategy, escalation paths, and resolution approaches. This position plays a critical role in driving timely, compliant, and financially sound outcomes while maintaining operational excellence in a fast- paced regulatory environment.

JOB REQUIREMENTS:

• Bachelor Degree and 3 years provider contracting experience OR 7 years business experience including 3 years provider contracting experience.
• 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; organizational and planning skills.
• PC proficiency to include Microsoft Office.
• Analytical skills.
• Ability and willingness to travel within assigned areas of responsibility, including overnight stays.

PREFERRED JOB REQUIREMENTS:

• Excel with experience in Vlook ups & Pivot Tables.
• Knowledgeable of the TX SB1264 Law.
• Effective time management skills.

This is a Telecommuter (Remote) role

Sponsorship is not available

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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.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$61,500.00 - $136,100.00

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