The Senior Provider Contracting Professional in the Central Region initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting.
Key Responsibilities
- Lead provider contracting activity for assigned markets, providers, and provider types within assigned territory.
- Negotiate and execute provider agreements, amendments, renewals, and terminations in alignment with enterprise network strategy
- Develop and maintain productive relationships with physician, provider groups, ancillary providers and hospitals.
- Resolve complex provider issues related to contract interpretation, escalations, and relationship management
- Partner with internal stakeholders to ensure provider contracts support affordability, quality, network adequacy, growth, and member access objectives
- Evaluate financial and operational impacts of proposed contract terms and reimbursement models
- Support implementation of shares savings value-based arrangements and quality rewards programs, where applicable
- Ensure contract terms comply with Humana policies, state and federal regulations, and internal governance requirements
- Collaborate with matrixed teams including legal, finance, network operations, credentialing, provider engagement, and clinical leadership
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
- 5+ years of progressive network management experience including hospital contracting and network administration in a healthcare company
- Experienced in negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems
- Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures, and reimbursement rates to providers
- Proficiency in MS Office applications
Preferred Qualifications
- Master's Degree
- Experience with ACO/Risk Contracting
- Experience with Value Based Contracting
Additional Information
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
