Humana

About Humana

 

Job Category:

Market Strategy - Contracting

Country:

United States

Postal Code:

32501

Approximate Salary:

Not Specified

Position Type:

Full time

Manager, Provider Contracting(Travel 50%: Northwest Counties in FL- Homes, Bay, Leon, Madison, Taylor, etc) Work at Home

Humana - Pensacola

Posted: 07/4/2018

Description

The Manager, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Manager, Provider Contracting works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

Location: Travel 50% Northwest counties in FL: Homes, Bay, Leon, Madison, Taylor, etc – Work at Home

The Manager, 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 resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

  • Lead Provider Contracting within a market
  • 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
  • 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
  • Ensure compliance of Medicaid requirements as it relates to Provider Network and Provider Relations operations
  • Strong focus on building and maintaining provider relationships, as well as ensuring all participating network providers are adequately trained on Humana’s policies and procedures, including but not limited to Medicaid requirements

               

Required Qualifications

  • Bachelor’s Degree in Business, Finance or a related field; or a minimum of 10 years’ provider contracting experience to include hospital contracting
  • A minimum of 5 years’ progressive contracting experience for a national health plan
  • Solid leadership/management experience including supervisory and teambuilding
  • Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
  • Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies

Preferred Qualifications

  • Master’s Degree in Business Administration or Finance
  • Experience with ACO/Risk Contracting
  • Value based contracting experience

Reporting RelationshipsThis position reports to a Contracting Director.Schedule: M-F 8 am to 5 pm

Scheduled Weekly Hours

40

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