[Remote] Senior Provider Contracting Professional at Humana

Florida, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Minimum of 3 years of progressive experience in network management, with a specific emphasis on advanced contracting for Primary Care Providers, Physician Groups, or Managed Service Organizations (MSOs) within the healthcare sector
Demonstrated expertise in negotiating Value-Based and managed care agreements with large physician organizations, particularly in support of Medicare and Medicaid Lines of Business contracting initiatives
Advanced ability to analyze, interpret, and clearly communicate the financial implications of contract terms, payment methodologies, and provider reimbursement structures
Exceptional written and verbal communication skills, supporting effective collaboration and negotiation with internal and external stakeholders
Proven capacity to successfully manage multiple, concurrent priorities in a dynamic, fast-paced environment
Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, Outlook) to support contract analysis, presentations, and documentation
Must live in the State of Florida, with the ability and willingness to travel within the state up to 25% of the time as required for provider engagement and contracting activities
Bachelor's degree

Responsibilities

Initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements
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
Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction

Skills

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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