DescriptionThe Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Provider Contracting Professional 2 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- Negotiate and re-negotiate high-volume, transactional-style physician and ancillary contracts.
- Function as the single point-of-contact for all on-going contractual and service issues as needed by providers.
- Facilitate provider education, training them in order to increase their familiarity and satisfaction with Humana’s systems and strategies.
- Create trend analyses and summaries for decision-making purposes.
- Interface with market leaders to align contracting needs and business efforts.
- Set targets and priorities in order to meet national and market-specific network needs.
- 2-5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts.
- Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
- Excellent written and verbal communication skills
- Ability to manage multiple priorities in a fast-paced environment
- Proficiency in MS Office applications
- Valid driver's license with reliable transportation and the ability to travel up to 30% within the region
- Bachelor's Degree
- Experience with ACO/Risk Contracting
- Experience with Value Based Contracting
Scheduled Weekly Hours40