Provider Contracting Professional 2

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. The Provider Contracting Professional 2 initiates, negotiates, and executes Large MSO/Physician Group, and/or other provider contracts and agreements. Your work assignments will be varied and frequently require interpretation and independent determination of appropriate courses of action. You will be responsible for daily issue resolution for your assigned MSOs and their Affiliate groups with direct contracts. Additional work includes KPI review, site visits, provider education, task submission, and system maintenance. This associate will work closely with key stakeholder teams such as Service Fund, STARS, MRA, Marketpoint, and Finance.

Responsibilities

• Initiate, negotiate, and execute Large MSO/Physician Group, and/or other provider contracts and agreements.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Analyze financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• May assist with identifying and recruiting providers based on network composition and needs.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Make decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed.
• Follow established guidelines/procedures.
• Resolve daily issues for assigned MSOs and their Affiliate groups with direct contracts.
• Conduct KPI reviews, site visits, and provider education.
• Submit tasks and perform system maintenance.
• Collaborate closely with key stakeholder teams such as Service Fund, STARS, MRA, Marketpoint, and Finance.

Requirements

• Required Qualifications:
  • 2 or more years of experience in negotiating or servicing managed care contracts.
  • Proficiency in analyzing, understanding, and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers.
  • Excellent written and verbal communication skills.
  • Ability to manage multiple priorities in a fast-paced environment.
  • Proficiency in MS Office applications.
  • Must live within the State of Florida.
  • Reliable transportation with the ability to travel within the region up to 25% of the time.
• Preferred Qualifications:
  • Bachelor's Degree.
  • Experience with ACO/Risk Contracting.
  • Experience with Value Based Contracting.

Work at Home Information

This position is considered "remote/work at home," however, you must live within the State of Florida to be considered for this opportunity.

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.
• Wireless, wired cable, or DSL connection is suggested.
• Satellite, cellular, and microwave connections can be used only if approved by leadership.

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. 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.

Additional Information

• Location Type: Remote/Work at Home
• 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.

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