Senior Provider Contracting Professional – Behavioral Health

🔥 0 minutes ago

🇺🇸 United States – 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 • Negotiate hospital and ancillary contracts at market-competitive pricing • Initiate and maintain long-term relationships with hospital and group practice administrators and members • Communicate contract terms, payment structures, and reimbursement rates to providers • Provide a comprehensive behavioral health hospital network for consumers • Re-prioritize corporate and consumer needs • Analyze the financial impact of contracts and terms • Maintain contracts and documentation in a tracking system • Identify and recruit providers based on network composition and needs • Communicate proactively with other departments to ensure effective and efficient business results • Manage services, levels of care, and pricing for the behavioral health network • Serve as subject matter expert for the assigned region and behavioral health network • Manage large accounts and provider relations • Interact with C-suite stakeholders internally and externally • Execute Humana's consumer-focused business strategy

🎯 Requirements

• 3–4 years of progressive network management experience, including hospital contracting and network administration in a healthcare company or healthcare system • Medicaid behavioral health contracting experience, including contract negotiation • Medicaid provider relations experience • Experience negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems • Proficiency analyzing, understanding, and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers • Bachelor's Degree is listed as a role desirable • Experience with ACO/Risk Contracting is desirable • Experience with Value Based Contracting is desirable • Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet • 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 • Whole-person well-being support • Occasional travel to Humana offices for training or meetings