Become a part of our caring community and help us put health first
 

The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for Humana's Behavioral Health business. 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.

The Senior Provider Contracting Professional for Behavioral Health/Medicaid communicates contract terms, payment structures, and reimbursement rates to providers. Providing a comprehensive hospital network to consumers in the behavioral health arena and executing on Humana's consumer-focused business strategy demands constant negotiation with a variety of provider constituencies and continual re-prioritization of corporate and consumer needs. 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.  In this role you will:

• Negotiate hospital and ancillary contracts at market competitive pricing.
• Initiate and maintain productive long-term relationships with key hospital and group practice administrators and members.
• Ability to have difficult conversations with individuals at all levels of the organization internally and externally
• Ability to adapt well when utilizing multiple new systems
• Communicate proactively with other departments in order to ensure effective and efficient business results.
• You will handle services and levels of care and pricing on the behavioral health network side
• Subject matter expert on their assigned region or states on all things behavioral health networks
• Manage large accounts and/or provider relations
• Will manage regional accounts
• Associate management oversight of 3-5 direct reports
• C-suite interactions both internally and externally
• Function independently and/or with limited direction on projects
• Manage multiple priorities in a fast-paced environment 

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Parental and caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities

Use your skills to make an impact
 

Required Qualifications

• 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
• Medicaid provider relations experience (face to face provider visits required)
• Experience with Community Mental Health Centers and their services
• Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems.
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Proficiency in MS Office applications 
• Ability to understand basic billing guidelines for various Medicaid states
• Occasional travel to providers within the region

Preferred Qualifications

• Bachelor's Degree
• Experience with ACO/Risk Contracting 
• Experience with Value Based Contracting

Additional Information

This position is considered "remote/work at home" however, you must be within driving distance to South Carolina and be willing and able to travel within the region, on occasion.

Work at Home Information

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by l