Provider Contracting Professional 2 - TRICARE EAST Region

Profile

Description

The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Role Overview


Establish and maintain an appropriate and viable network of providers throughout their assigned prime service areas (PSAs) for TRICARE.
Target providers for inclusion in the network based on network development strategy and complete contracts including the negotiation of discount rates.
Develop and implement a renegotiation strategy to insure HUMANA GOVERNMENT BUSINESS meets or exceeds the discount guarantee.
Develop and maintain a cost effective provider network in the required PSAs. Requirements include achieving budgeted discount percentages and network size to satisfy our network goals for new and existing providers
Participate in market network collaboration meetings in order to foster greater understanding of the TRICARE program and improve cost awareness.
Insure that newly contracted providers submit accurate initial contract packages.


Our Department of Defense Contract requires U.S. Citizenship

Required Qualifications


Bachelor's degree plus 1 or more years provider and customer relations experience; if non-degreed, must have 3 years or more of provider and customer relations experience
Previous experience in provider contracting and/or negotiations/sales
Strong written communication and presentation skills
Strong PC skills, including business software
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Our Department of Defense Contract requires U.S. Citizenship
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)


Work at Home Requirements


At this time, this position is a work at home based position and you must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work (See additional information below)
Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)


Preferred Qualifications


Two or more years' experience in a dealing with managed care or insurance issues (i.e. benefits, claims, etc.)
Knowledge of the TRICARE program and other Government contracting experience as well as the different reimbursement methodologies being employed.


Additional Information

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire Text to enhance our hiring and decision-making ability. Modern Hire Text allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Modern Hire Text interview. In this interview, you review a set of interview questions over your phone and you will provide text responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your text message interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews

Scheduled Weekly Hours

40

Company info

Sign Up Now - MiamiCrossing.com