[Remote] Provider Contracting Professional 2 at Humana

Florida, United States

Humana Logo
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

  • 2+ years of experience in negotiating or servicing managed care contracts
  • Understanding of contract terms, payment structures and reimbursement rates
  • Excellent written and verbal communication skills
  • Ability to manage multiple priorities in a fast-paced environment
  • Proficiency in MS Office applications
  • Live in the State of Florida with the ability and willingness to travel on occasion

Responsibilities

  • Initiates, negotiates, and executes physician, hospital, and/or other provider contracts
  • 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

Skills

Key technologies and capabilities for this role

Contract NegotiationManaged Care ContractsPayment StructuresReimbursement RatesMS OfficeProvider ContractingACO ContractingRisk ContractingValue Based Contracting

Questions & Answers

Common questions about this position

What is the pay range for this position?

The compensation range reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting, and it may be higher or lower based on geographic location and individual factors. The exact range is not fully specified in the description.

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

This role is remote/work at home, but you must live in the State of Florida to be considered. Occasional travel to Humana's offices for training or meetings may be required.

What are the required qualifications for this role?

Required qualifications include 2+ years of experience in negotiating or servicing managed care contracts, understanding of contract terms, payment structures and reimbursement rates, excellent written and verbal communication skills, ability to manage multiple priorities in a fast-paced environment, proficiency in MS Office applications, and living in Florida with willingness to travel occasionally.

What preferred qualifications are there for this position?

Preferred qualifications include a Bachelor's degree, experience with ACO/Risk Contracting, and experience with Value Based Contracting.

What home office setup is required for this remote role?

You must have self-provided internet with at least 25 Mbps download and 10 Mbps upload speed, work from a dedicated space without interruptions to protect PHI/HIPAA information, and Humana provides telephone equipment. Certain states like California receive bi-weekly internet expense payments.

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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