Humana

Senior Provider Contracting Professional (Behavioral Health/Medicaid)

Virginia, United States

Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Behavioral Health, MedicaidIndustries

Requirements

Candidates must have 3-5 years of progressive network management experience, including hospital contracting and network administration in a healthcare company. They should be experienced in negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems, and proficient in analyzing and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers. Experience with Behavioral Health contracts, excellent written and verbal communication skills, the ability to manage multiple priorities in a fast-paced environment, and proficiency in MS Office applications are also required. Candidates must live within reasonable driving distance of Virginia. A Bachelor's degree and experience with Medicaid contracts are preferred.

Responsibilities

The Senior Provider Contracting Professional will initiate, negotiate, and execute physician, hospital, and/or other Behavioral Health contracts and agreements within the Virginia Medicaid space. They will communicate contract terms, payment structures, and reimbursement rates to providers to build and maintain Medicaid Behavioral Health provider networks, and analyze the financial impact of contracts. This role involves maintaining contracts and documentation within a tracking system, assisting with provider identification and recruitment based on network needs, and influencing department strategy. The professional will make decisions on moderately complex to complex issues regarding technical project components with minimal direction.

Skills

Provider Contracting
Behavioral Health
Medicaid
Network Management
Hospital Contracting
Network Administration
Managed Care Contracts
Financial Analysis
Contract Negotiation
MS Office

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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