Senior Provider Contracting Professional at Humana

Atlanta, Georgia, United States

Humana Logo
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

  • 3 or more years of progressive experience in network management and network administration in a healthcare company
  • Experience analyzing, understanding and communicating 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

Responsibilities

  • Initiates, negotiates, and executes physician, hospital, and/or other provider contracts
  • 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

Skills

Key technologies and capabilities for this role

Provider ContractingNetwork ManagementContract NegotiationFinancial AnalysisReimbursement RatesPayment StructuresMS OfficeACO ContractingRisk ContractingValue Based Contracting

Questions & Answers

Common questions about this position

What is the pay range for this position?

The compensation range reflects a good faith estimate of starting base pay for full time (40 hour) positions, but the specific range is not detailed in the job description.

Is this role remote, and what are the location requirements?

This role is considered 'remote/work at home', with preference given to candidates located within the Atlanta region. Local candidates will be required to travel into Humana's Atlanta (Riverwood) office for bi-weekly team meetings and occasional events.

What are the required qualifications for this role?

Required qualifications include 3 or more years of progressive experience in network management and network administration in a healthcare company, experience analyzing and communicating 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, and proficiency in MS Office applications.

What work arrangement details are provided for remote employees?

Remote employees must have self-provided internet with at least 25 Mbps download and 10 Mbps upload speeds, work from a dedicated space to protect PHI/HIPAA information, and will be provided telephone equipment. Employees in California, Illinois, Montana, or South Dakota receive a bi-weekly internet expense payment.

What preferred qualifications will strengthen my application?

Preferred qualifications include a Bachelor's degree, experience negotiating provider contracts, experience with ACO/Risk Contracting, experience with Value Based Contracting, and living within the State of Georgia.

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.

Land your dream remote job 3x faster with AI