Senior Provider Contracting Professional

San Antonio, Texas, 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 experience, including negotiating managed care contracts with physician groups and ancillary providers. Proficiency in analyzing and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers is essential. Strong skills in MS Office applications and the ability to manage multiple priorities in a fast-paced environment are required. Applicants must reside in the Eastern or Central Time Zone. A Bachelor's degree, experience with North Carolina providers, ACO/Risk Contracting, and Value Based Contracting are preferred qualifications.

Responsibilities

The Senior Provider Contracting Professional will initiate, negotiate, and execute contracts and agreements with physicians, ancillary providers, hospitals, and other providers. This role involves analyzing complex situations and data to evaluate variable factors, communicating contract terms, payment structures, and reimbursement rates to providers in the North Carolina Market, and analyzing the financial impact of contracts. The professional will maintain contracts and documentation within a tracking system and may assist with provider identification and recruitment based on network needs. They will make decisions on technical approaches for project components without direction and exercise considerable latitude in determining objectives and approaches.

Skills

Provider Contracting

Negotiation

Managed Care Contracts

Physician Groups

Ancillary Providers

Financial Analysis

Contract Terms

Payment Structures

Reimbursement Rates

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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