Provider Contracting Executive

Florida, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates must have 5 or more years of progressive network management experience, including hospital contracting and network administration in a healthcare company, and at least 2 years of project leadership experience. Extensive provider contracting skills, including contract negotiation, preparation, implementation, financial analysis, and rate proposal development are required. Excellent written and verbal communication skills with experience presenting to varied audiences and the ability to manage multiple priorities in a fast-paced environment are necessary. A working knowledge of Microsoft Office applications is also required. Experience with ACO/Risk Contracting and Value Based Contracting is preferred, and candidates must reside in Florida.

Responsibilities

The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and other provider contracts and agreements. They communicate contract terms, payment structures, and reimbursement rates to providers, and analyze the financial impact of contracts and terms. Maintaining contracts and documentation within a tracking system is a key responsibility, and they may assist with identifying and recruiting providers. The role involves advising executives on functional strategies and exercising independent judgment and decision-making on complex issues.

Skills

Provider Contracting

Contract Negotiation

Financial Analysis

Rate Proposal Development

Network Management

Hospital Contracting

Network Administration

Project Leadership

ACO Contracting

Risk Contracting

Value Based Contracting

Microsoft Office

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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