[Remote] Senior Provider Contracting Professional at Humana

Washington, District of Columbia, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Bachelor’s Degree
5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems
Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers
Demonstrated ability to articulate ideas effectively in both written and oral forms
Ability to manage multiple priorities in a fast-paced environment
Proficiency in MS Office applications
Preferred Qualifications
Experience contracting for Medicaid in Washington state
Master's Degree
Experience with ACO/Risk Contracting
Experience with Value Based Contracting

Responsibilities

Initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance
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
Begins to influence department’s strategy
Makes decisions on moderately complex issues regarding technical approach for project components, and work is performed with minor direction

Skills

Key technologies and capabilities for this role

Provider ContractingContract NegotiationManaged Care ContractsNetwork ManagementHospital ContractingFinancial AnalysisReimbursement RatesPayment StructuresMS OfficeMedicaid ContractingACO ContractingValue Based Contracting

Questions & Answers

Common questions about this position

What qualifications are required for the Senior Provider Contracting Professional role?

A Bachelor’s Degree and 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company are required. Additional requirements include experience negotiating managed care contracts with large physician groups, ancillary providers and hospital systems, proficiency in analyzing financial impact of contract terms, and strong communication skills.

Is this a remote position, and what are the internet requirements?

This is a Work at Home / Internet position or Hybrid Home/Office role. Employees must have self-provided internet with at least 25 Mbps download and 10 Mbps upload speeds; certain states receive bi-weekly internet expense payments, and Humana provides telephone equipment.

What is the salary or compensation for this position?

This information is not specified in the job description.

What preferred qualifications would make me stand out for this role?

Preferred qualifications include experience contracting for Medicaid in Washington state, a Master’s Degree, and experience with ACO/Risk Contracting or Value Based Contracting.

What is the work environment like for this position?

The role involves managing multiple priorities in a fast-paced environment with moderately complex issues, performed with minor direction and considerable latitude in determining objectives.

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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