Provider Contracting Professional - Behavioral Health/Medicaid

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must have at least 2 years of experience in servicing or negotiating managed care contracts. They should possess proficiency in analyzing and communicating the financial impacts of contract terms, payment structures, and reimbursement rates to providers. Excellent written and verbal communication skills, proficiency in MS Office applications, and the ability to manage multiple priorities in a fast-paced environment are also required. A Bachelor's Degree and experience with behavioral health or Medicaid contracting are preferred.

Responsibilities

The Provider Contracting Professional will initiate, negotiate, and execute behavioral health provider contracts, communicating contract terms, payment structures, and reimbursement rates to providers in new Medicaid Behavioral Health network builds. This role involves analyzing the financial impacts of contracts, maintaining contracts and documentation within a tracking system, and identifying and recruiting providers based on network needs. The professional will engage in contracting negotiations with Behavioral Health physicians and Community Mental Health providers, making decisions on moderately complex issues regarding technical approach for project components.

Skills

Managed care contracts

Contract negotiation

Financial analysis

MS Office

Behavioral health

Medicaid

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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