[Remote] Director, Provider Contracting at Humana

South Carolina, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor's Degree
8+ years of progressive experience in provider contracting to include all provider types (hospital, IDN, physician, ancillary)
Proven leadership experience, including teambuilding
Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
Value based contracting experience
Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
Must live within the region (South Carolina)

Responsibilities

Initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements
Communicates contract terms, payment structures, and reimbursement rates to providers
Analyzes financial impact of contracts and terms
Maintains contracts and documentation within a tracking system
May assist with identifying and recruiting providers based on network composition and needs
Makes decisions related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes
Implements strategic plans, drives goals and objectives, and improves performance
Provides input into functions strategy

Skills

Key technologies and capabilities for this role

Provider ContractingContract NegotiationMedicare ReimbursementValue Based ContractingFinancial AnalysisACO ContractingRisk ContractingTeam LeadershipContract Management

Questions & Answers

Common questions about this position

What is the pay range for this Director, Provider Contracting role?

This information is not specified in the job description.

Is this a remote position, and are there any location requirements?

This role is remote/work at home, but you must live within the South Carolina region. Occasional travel to Humana's offices for training or meetings may be required.

What are the required qualifications and skills for this position?

A Bachelor's Degree, 8+ years of progressive experience in provider contracting across all provider types, proven leadership experience including teambuilding, proven contract preparation skills with knowledge of Medicare reimbursement methodologies, value-based contracting experience, and strong financial acumen are required.

What work arrangement details are provided for remote employees?

Remote employees must have self-provided internet with at least 25 Mbps download and 10 Mbps upload speeds, work from a dedicated space to protect PHI/HIPAA information, and Humana provides telephone equipment. Employees in certain states like California receive bi-weekly internet expense payments.

What experience makes a candidate stand out for this role?

Candidates with a Master's or J.D., experience in Medicare/Medicaid contracting, ACO/Risk Contracting, and familiarity with key providers in the South Carolina market will stand out.

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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