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DescriptionThe Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.ResponsibilitiesThe Senior Provider Contracting Professional 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 to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.Required QualificationsAbility to manage multiple priorities in a fast-paced environment
Ability to adapt, learn and utilize Humana internal systems and applications to support contract negotiations and related activities
3+ years of progressive network management experience that may include contracting, network administration, operations or a combination of these area in a healthcare company or related experience
An understanding of negotiating managed care contracts with large physician groups, ancillary providers and/or hospital systems or related experience working with provider groups
Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
Excellent written and verbal communication skills
Proficiency in MS Office applications
Preferred QualificationsBachelor's or Master's Degree (MHA, MBA, etc.)
Experience with ACO/Risk Contracting
Experience with Value Based Contracting
Additional InformationHumana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.Scheduled Weekly Hours40Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.
