Provider Contracting Executive

Profile

Description

The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. The Provider Contracting Executive engages in strategic negotiation and relationship-building with a variety of provider constituencies across all product lines, including Medicare, Medicaid and commercial. Primarily highly complex contracting arrangements.

Responsibilities

The Provider Contracting Executive communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and path to value agreements. Maintains contracts and documentation within a tracking system. Identifies and recruit providers based on network composition and needs. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Negotiates and renegotiates value based and highly complex provider contracts that are financially favorable to Humana's business, including reaching settlement arrangements (with finance)Delivers a contract that can be operationalized, and maintained.Collaborates with Contract administrator/specialist counterpart to ensure smooth transition from Contracting through AdministrationEnsure that our networks are competitive within the industry by helping facilitate Sales' ability to penetrate new business opportunities. Initiate and maintain productive long-term relationships with market leaders, key providers and practice administrators *Create and maintain operations meetings (note that the term 'SOC' may be used by some markets more broadly to mean any operations meeting ) and strategic relationships for specialists, hospitals and IDSs.Educate non-PCPs about Humana's ever-expanding portfolio of products and services, ensuring continually updated knowledge about the company's offerings

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

o Medical Benefits

o Dental Benefits

o Vision Benefits

o Health Savings Accounts

o Flex Spending Accounts

o Life Insurance

o 401(k)

o PTO including 7 paid holidays, two personal holidays, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time

o And more

Required Qualifications


Bachelor's degree
5 years of experience working in the healthcare industry
2 years of project leadership experience
Extensive provider contracting skills, including contract preparation and/or implementation, financial analysis and rate proposal development
Excellent written and verbal communication skills and experience presenting to varied audiences
Ability to manage multiple priorities in a fast-paced environment
Knowledge of Microsoft Office applications
Valid driver's license with the ability to travel within the region up to 20% of the time


Preferred Qualifications


Master's Degree
Experience working with Medicaid contracts
Experience with hospital contracting
Experience with ACO/Risk Contracting
Experience with Value Based Contracting


Additional Information

This role is considered remote/work at home and can be based anywhere in the United States.


WAH 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


Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of COVID-19 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.

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 ****

Company info

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