Senior Provider Contracting Professional

Texas, 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 at least 2 years of network management experience, including provider and hospital contracting and network administration within a healthcare company or related field. Experience with managed care contracts for large physician groups, ancillary providers, or hospital systems is required, along with proficiency in MS Office applications. Travel up to 20% within Texas is also a requirement.

Responsibilities

The Senior Provider Contracting Professional will initiate, negotiate, and execute provider contracts and agreements, communicating contract terms, payment structures, and reimbursement rates. Responsibilities include analyzing the financial impact of contracts, maintaining contracts in a management system, identifying and recruiting providers, and contributing to department strategy development.

Skills

Provider Contracting

Negotiation

Contract Management Systems

Network Management

Managed Care Contracts

MS Office Suite

ACO/Risk Contracting

Value Based Contracting

Financial Analysis

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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