Senior Provider Contracting Professional

Employment Type: Full-time

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, ancillary, hospital, and/or other provider contracts and agreements. This role involves moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers for the North Carolina Market. They will analyze the financial impact of contracts and terms, and maintain contracts and documentation within a tracking system. This position may also assist with identifying and recruiting providers based on network composition and needs. The Senior Provider Contracting Professional makes decisions on moderately complex to complex issues regarding technical approach for project components and works without direction, exercising considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

• 3 or more years of progressive network management experience.
• Experienced in negotiating managed care contracts with physician groups and ancillary providers.
• Proficiency in analyzing, understanding, and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in MS Office applications.
• Must live in Eastern or Central Time Zone.

Preferred Qualifications

• Bachelor's degree.
• Experience working with North Carolina providers.
• Experience with ACO/Risk Contracting.
• Experience with Value Based Contracting.
• Located in North Carolina.

Work Environment & Additional Information

• Work Location: This role is "remote/work at home".
• Time Zone Requirement: To be considered for this opportunity, you must live within the Eastern or Central Time Zone.
• Internet Service: For Home or Hybrid Home/Office employees, self-provided internet service must meet the following criteria:
  • Minimum download speed of 25 Mbps and an upload speed of 10 Mbps.
  • Wireless, wired cable, or DSL connection is suggested.
  • Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Internet Expense Reimbursement: Employees who live and work from Home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Telephone Equipment: Humana will provide Home or Hybrid Home/Office employees with appropriate telephone equipment to meet business requirements.
• Work Space: 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.

Compensation & Incentives

• Scheduled Weekly Hours: 40
• Pay Range: $78,400 - $107,800 per year. This range reflects a good faith estimate of starting base pay. Actual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, and geographic location.
• Bonus Incentive: This job is eligible for a bonus incentive plan based on company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries offer 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, while also acknowledging that life extends beyond work. Benefits include:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, volunteer time off).