Dental Provider Contracting Professional 2-VSP

New York, New York, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Part TimeJob Type

UnknownVisa

Health InsuranceIndustries

Requirements

Candidates must possess a Bachelor's degree and 2-5 years of experience in negotiating managed care contracts with providers. Required skills include proficiency in analyzing financial impacts of contract terms, payment structures, and reimbursement rates, excellent written and verbal communication, and the ability to manage multiple priorities in a fast-paced environment. Proficiency in MS Office applications and a passion for improving consumer experiences are also necessary. Preferred qualifications include a Master's Degree and experience with ACO/Risk Contracting or Value Based Contracting.

Responsibilities

The Provider Contracting Professional initiates, negotiates, and executes provider contracts and agreements. They communicate contract terms, payment structures, and reimbursement rates to providers, and analyze the financial impact of these contracts. This role involves maintaining contracts and documentation within a tracking system and may include assisting with provider recruitment. The professional must understand departmental and organizational strategy and make independent decisions regarding work methods.

Skills

Managed care contracting

Contract negotiation

Financial analysis

Reimbursement rates

MS Office

ACO

Risk contracting

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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