Senior Provider Contracting Professional

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 at least 3 years of progressive network management and administration experience in a healthcare company, with proven experience negotiating managed care contracts with large physician groups. Proficiency in analyzing and communicating financial impacts of contract terms, payment structures, and reimbursement rates is required, along with excellent written and verbal communication skills, the ability to manage multiple priorities in a fast-paced environment, and proficiency in MS Office applications. Candidates must reside within the State of Florida. A Bachelor's Degree, experience with ACO/Risk Contracting, and experience with Value Based Contracting are preferred.

Responsibilities

The Senior Provider Contracting Professional initiates, negotiates, and executes physician and other provider contracts and agreements for the Florida Region. This role involves analyzing complex situations and evaluating variable factors to communicate contract terms, payment structures, and reimbursement rates to providers. Responsibilities include analyzing the financial impact of contracts, maintaining contracts and documentation within a tracking system, and potentially assisting with provider recruitment. The professional will make decisions on technical approaches for project components without direction.

Skills

Provider Contracting

Negotiation

Managed Care Contracts

Financial Analysis

Contract Management

Network Management

Healthcare

MS Office

ACO Contracting

Risk Contracting

Value Based Contracting

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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