Senior Provider Contracting Professional

Employment Type: Full-time Location Type: Remote/Work at Home (Must reside in the State of Florida) Pay Range: $78,400 - $107,800 per year Bonus: Eligible for a bonus incentive plan based on company and/or individual performance.

Position Overview

Become a part of our caring community and help us put health first. The Senior Provider Contracting Professional initiates, negotiates, and executes physician and/or other provider contracts and agreements. This role involves moderately complex to complex issues requiring in-depth evaluation of variable factors. The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers, analyzes the financial impact of contracts, and maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Exercises considerable latitude in determining objectives and approaches to assignments, making decisions on moderately complex to complex issues regarding technical approach for project components without direction. Additionally, reviews key performance indicators with assigned providers, performs site visits, creates action plans, and documents actionable items.

Requirements

• Required Qualifications:
  • 3 or more years of progressive network management experience, including provider contracting and/or provider relations/operations in a healthcare or MSO/IPA company.
  • Proficiency in analyzing, understanding, and communicating the financial impact of contract terms, payment structures, reimbursement rates, and key performance indicators to providers.
  • Excellent written and verbal communication skills.
  • Ability to manage multiple priorities in a fast-paced environment.
  • Proficiency in MS Office applications.
  • Ability to resolve problems independently.
  • Must live in the State of Florida.
• Preferred Qualifications:
  • Bachelor's Degree.
  • Experience negotiating provider contracts.
  • Experienced working with large physician groups in provider relations or operations.
  • Experience with Risk Contracting.
  • Experience with Value-Based Contracting.

Responsibilities

• Initiate, negotiate, and execute physician and/or other provider contracts and agreements.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Analyze the 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.
• Review key performance indicators with assigned providers.
• Perform site visits.
• Create action plans and document actionable items.

Work at Home Information

• This role is considered "remote/work at home," but you must live/work in the State of Florida.
• Internet Service Criteria:
  • Minimum download speed of 25 Mbps and upload speed of 10 Mbps is recommended.
  • Wireless, wired cable, or DSL connection is suggested.
  • Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Employees living and working from home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide appropriate telephone equipment for Home or Hybrid Home/Office employees.
• Employees must 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.

Company Information

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family.