[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

Candidates must possess a Bachelor's Degree and a minimum of 5 years of progressive network management experience, including hospital contracting and network administration within a healthcare company. Experience in negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems is required, along with proficiency in analyzing and communicating the financial impact of contract terms, payment structures, and reimbursement rates. The ability to articulate ideas effectively in both written and oral forms, and to manage multiple priorities in a fast-paced environment, is essential. Proficiency in MS Office applications is also necessary.

Responsibilities

The Senior Provider Contracting Professional initiates, negotiates, and executes contracts and agreements with physicians, hospitals, and other providers. They communicate contract terms, payment structures, and reimbursement rates to providers and analyze the financial impact of these contracts. This role involves maintaining contracts and documentation within a tracking system, and may include assisting with provider identification and recruitment. The professional influences department strategy and makes decisions on moderately complex technical approaches for project components with minimal direction.

Skills

Provider Contracting

Negotiation

Managed Care Contracts

Network Management

Hospital Contracting

Network Administration

Financial Analysis

MS Office

Medicaid Contracting

ACO/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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