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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.

The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers. Provides a comprehensive hospital network to consumers in the behavioral health arena and executes on Humana's consumer-focused business strategy. The Senior Provider Contracting Professional will negotiate with a variety of provider constituencies and provide 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. 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
• Communicate proactively with other departments in order to ensure effective and efficient business results
• Handle services, levels of care, and pricing on the behavioral health network side
• Subject matter expert on the assigned region/behavioral health network
• Manage large accounts and/or provider relations
• Be comfortable with C-suite interactions, both internally and externally

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, to include contract negotiation

• Medicaid provider relations experience

• Experienced in negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems

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

Role Desirables

• Bachelor's Degree

• Experience with ACO/Risk Contracting 

• Experience with Value Based Contracting

Additional Information

This role is "remote/work at home" and can be based anywhere in the United States, however, preference will be given to candidates that are located in the Eastern or Central Time Zone.

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$78,400 - $107,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated su