Senior Hospital Contracting Strategist

🔥 0 minutes ago

🐊 Florida, Texas, +3 more states – Remote

🐊 Florida – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟠 Senior

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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 physician, hospital, and other provider contracts and agreements • Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value-based agreements • Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements • Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable • Communicate contract terms, payment structures, and reimbursement rates to providers • Analyze the financial impact of contracts and terms • Maintain contracts and documentation within a tracking system • Help identify and recruit providers based on network composition and needs • Report to the Director, Provider Contracting • Work 8am to 5pm EST, with travel based on business needs

🎯 Requirements

• Bachelor's degree • 5 or more years of hospital negotiation experience in Medicare • 5 or more years of progressive network management experience, including hospital contracting and network administration in a healthcare company • Experience negotiating managed care contracts with hospital systems, post-acute providers, ancillary providers, and physicians • Ability to analyze, understand, and communicate the financial impact of contract terms, payment structures, and reimbursement rates to providers • Ability to understand and interpret hospital contract language • Proficiency in Microsoft Office: Word, Excel, and PowerPoint • Master's degree preferred • Experience with ACO/Risk Contracting preferred • Experience with Value Based Contracting preferred • Minimum download speed of 25 Mbps and upload speed of 10 Mbps • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • 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 • Occasional travel to Humana offices for training or meetings