Provider Network Specialist - TRICARE

Position Overview

Become a part of our caring community and help us put health first. This role involves establishing and maintaining an appropriate and viable network of providers throughout assigned prime service areas (PSAs) for TRICARE. You will target providers for inclusion in the network based on the network development strategy and complete contracts, including the negotiation of discount rates. A key responsibility is to develop and implement a renegotiation strategy to ensure HUMANA GOVERNMENT BUSINESS meets or exceeds the discount guarantee.

Key Accountabilities

• Develop and maintain a cost-effective provider network in the required PSAs.
• Achieve budgeted discount percentages and network size to satisfy network goals for new and existing providers.
• Participate in market network collaboration meetings to foster a greater understanding of the TRICARE program and improve cost awareness.
• Ensure that newly contracted providers submit accurate initial contract packages.

Requirements

Required Qualifications

• U.S. citizenship is required due to Department of Defense Contract requirements.
• Must successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing).
• HGB is not authorized to do work in Puerto Rico per our government contract. Candidates currently living in Puerto Rico cannot be hired.
• Bachelor's degree and 1 or more years of provider/customer relations experience.
  • If non-degreed, must have 3 or more years of provider/customer relations experience.
• Must be able to work 8 a.m. - 5 p.m. in the central or eastern time zone.
• Previous experience in provider contracting and/or negotiations/sales.

Preferred Qualifications

• Knowledge of the TRICARE program and other Government contracting experience.
• Familiarity with different reimbursement methodologies.
• 2 or more years of experience dealing with managed care or insurance issues (e.g., benefits, claims, etc.).

Work-At-Home Requirements

• Internet Service: Self-provided internet service must meet the following criteria:
  • Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended.
  • Wireless, wired cable, or DSL connection suggested.
  • Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Internet Reimbursement: Associates living and working from home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Equipment: Humana will provide telephone equipment appropriate to meet the business requirements for the position.
• Work Environment: Must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Responsibilities

• Establish and maintain an appropriate and viable network of providers.
• Target providers for inclusion in the network based on strategy.
• Complete provider contracts, including negotiating discount rates.
• Develop and implement a renegotiation strategy to meet discount guarantees.
• Ensure new providers submit accurate initial contract packages.
• Participate in market network collaboration meetings.

Employment Type

• Full-time

Location Type

• Remote (with occasional travel)

Travel

• Occasional travel to Humana's offices for training or meetings may be required.

Compensation

• Pay Range: $65,000 - $88,600 per year
  • This range reflects a good faith estimate of starting base pay for full-time employment. Actual pay may vary based on geographic location, demonstrated skills, knowledge, experience, education, and certifications.
• Bonus Incentive Plan: This job is eligible for a bonus incentive plan based on company and/or individual performance.

Company Information

Humana, Inc. and its affiliated subsidiaries offer competitive benefits designed to encourage personal wellness and smart healthcare decisions for associates and their families. Benefits include medical, dental, and vision coverage, a 401(k) retirement savings plan, and time off (including paid time off, company and personal holidays, volunteer time).