DescriptionThe Director, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Director, Provider Contracting requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
The Director, Provider Contracting 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. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.
- The Contracting and Operations Director will lead and manage the development of Humana’s overall provider relationships within a geographic region. Drive strategic initiatives within the provider network and ensure that the alignment of departmental objectives is congruent with the overall business strategy.
- Lead Provider Contracting within a region, Commercial, Medicare Advantage and Medicaid
- Initiate and maintain productive long-term relationships with provider representatives, subscribers, hospitals, account managers and internal sales teams
- Provide effective operations management, ensuring that all contracts are within required guidelines and financial parameters, and maintain current provider data within payment systems
- Apply economic and strategic planning models to all endeavors in your region in order to align business, process, and operational principles with area-specific goals
- Bachelor's Degree or equivalent
- Extensive provider contracting experience
- Proven leadership experience, including teambuilding
- Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
- Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
- Master's or J.D. Degree
- Experience with ACO/Risk Contracting
- Value based contracting experience
Scheduled Weekly Hours40