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Senior Provider Contracting Professional at Humana

Senior Provider Contracting Professional

Humana Atlanta, GA Full-Time
**Description**

The 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.

**Responsibilities**

The 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 Qualifications**

+ Bachelor's degree or equivalent experience

+ **MUST** reside in GA or a border county in SC, TN or AL

+ up to 25% travel within the state of GA

+ 3 or more years of progressive provider network management experience in a healthcare company

+ Experienced in negotiating managed care contracts with large physician groups and ancillary providers

+ Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.

+ Excellent written and verbal communication skills

+ Ability to manage multiple priorities in a fast-paced environment

+ Proficiency in MS Office applications

+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Humana 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.

**Preferred Qualifications**

+ Master's Degree

+ Experience with ACO/Risk Contracting

+ Experience with Value Based Contracting

**Additional Information**

**Work-At-Home Requirements**

* Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

* A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

* Satellite and Wireless Internet service is NOT allowed for this role.

* A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

**Scheduled Weekly Hours**

40

Humana 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 [ Link removed ] - Click here to apply to Senior Provider Contracting Professional

Recommended Skills

  • Communication
  • Finance
  • Health Care
  • Managed Care
  • Microsoft Office
  • Negotiation
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Job ID: 2288792824

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