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.
ResponsibilitiesLocation: Travel 50% - 70% all throughout Volusia and surrounding areas, FL
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.
- Bachelor’s Degree in Business, Finance or a related field or a minimum of 5 years’ relevant provider contracting experience.
- Prior demonstrated success in provider contracting with both large physician groups and ancillary providers.
- Proficiency in analyzing, understanding and communicating financial trends
- Excellent written and verbal communication skills
- Experience presenting to varied audiences
- Ability to manage multiple priorities in a fast-paced environment
- Knowledge of Microsoft Office applications
- Driver’s license and vehicle are required
- Master’s Degree in Business Administration or a related field Experience with ACO/Risk Contracting
- Working knowledge in the areas of Group Practice Management, Long-Term Acute Care, home health, home infusion, behavioral health, ambulatory surgery, and the outpatient experience
This position reports to a Director of Contracting.
Additional InformationSchedule: Monday to Friday from 8 am to 5 pm. Occasional travel outside of market. Some evenings, weekeend events a few times a yearTraining: On-site training in Daytona market office
Scheduled Weekly Hours40