DescriptionThe 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. 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. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
- Typically requires Bachelor's degree or equivalent
- Department of Defense contract requires U.S Citizenship for this role
- 5+ years of progressive network management experience including hospital contracting and network administration in a healthcare company
- Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems.
- 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
- Master's Degree
- Experience with ACO/Risk Contracting
- Experience with Value Based Contracting
- This job is WAH anywhere
- If offered a position with Humana Government Business you would be required to go through the eQIP process to obtain Government Security Clearance to work on government systems. This requires the completion of a 100+ page document on-line, finger printing, background check, credit check and, completion of an employment application and drug test. The financial/credit check portion requires an in depth review of any failure to meet financial obligations within the past 7 years, including but not limited to bankruptcy, debt over 120 days delinquent and/or $15,000 threshold for bad debt (items in collection and charge off).
Scheduled Weekly Hours40