Provider Contracting Professional – Behavioral Health, Medicaid

🔥 0 minutes ago

🌲 North Carolina, South Carolina – Remote

🌲 North Carolina – Remote 🌴 South Carolina – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Initiate, negotiate, and execute behavioral health provider contracts for South Carolina Medicaid • Communicate contract terms, payment structures, and reimbursement rates to Behavioral Health providers • Analyze the financial impacts of contracts and contract terms • Maintain contracts and documentation within a tracking system • Identify and recruit providers based on network composition and needs • Make decisions on moderately complex issues regarding technical approaches for project components • Engage in contracting negotiations with Behavioral Health physicians and Community Mental Health providers • Determine objectives and approaches to assignments with considerable latitude

🎯 Requirements

• 2+ years of experience negotiating or servicing managed care contracts with physician, hospital, and/or other providers • Proficiency analyzing, understanding, and communicating the financial impacts of contract terms, payment structures, and reimbursement rates to providers • Must live within the market, including South Carolina, North Carolina, or Georgia • Experience with behavioral health contracts preferred • Experience working with Medicaid contracts preferred • Bachelor's Degree preferred • Minimum 25 Mbps download and 10 Mbps upload internet connection for work-from-home employees • Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Occasional travel to Humana offices for training or meetings may be required

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Work-from-home arrangement