Director, Provider Contracting
About The Position
The Director, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for a health insurance organization. The role requires an in-depth understanding of how organizational capabilities interrelate across the function or segment. The Director communicates contract terms, payment structures, and reimbursement rates to providers; analyzes the financial impact of contracts and terms; and maintains contracts and documentation in a tracking system. The role may assist with identifying and recruiting providers based on network composition and needs. Decisions typically relate to implementing new or updated programs and large-scale projects, supporting technical and operational procedures and processes, implementing strategic plans, driving goals and objectives, and improving performance. The Director also provides input into the function's strategy. This is a remote/work-at-home role, but the employee must live in the Northeast Region: MD, DC, DE, PA, NJ, NY, CT, MA, ME, NH, VT, or RI. A dedicated work space without ongoing interruptions is required to protect member PHI/HIPAA information. Internet service must provide at least 25 Mbps download and 10 Mbps upload; wireless, wired cable, or DSL is suggested. Occasional travel to Humana offices for training or meetings may be required. The role is scheduled for 40 hours per week.
Requirements
- Bachelor’s degree in Business, Finance, or a related field, or a minimum of 10 years of provider contracting experience including hospital and value-based contracting.
- A minimum of 5 years of contracting experience, including hospital and value-based contracting.
- Experience leading people or projects.
- Strong financial acumen and proficiency in analyzing and interpreting financial trends in provider contracting.
- Proven contract preparation and negotiation skills.
- In-depth knowledge of Medicare contracting, including value-based/incentive contracting experience.
- Must live within the Northeast Region: MD, DC, DE, PA, NJ, NY, CT, MA, ME, NH, VT, or RI.
- For work at home, self-provided internet service must have at least 25 Mbps download and 10 Mbps upload, and the employee must have a dedicated work space without ongoing interruptions to protect member PHI/HIPAA information.
Nice To Haves
- Master’s degree in Business Administration or Finance.
- Experience with ACO/risk contracting.
Responsibilities
- Initiate, negotiate, and execute physician, hospital, and/or other provider contracts and agreements.
- Communicate contract terms, payment structures, and reimbursement rates to providers.
- Analyze the financial impact of contracts and contract terms.
- Maintain contracts and documentation within a tracking system.
- Assist with identifying and recruiting providers based on network composition and needs.
- Implement new or updated programs and large-scale projects, including supporting technical and operational procedures and processes.
- Implement strategic plans, drive goals and objectives, and improve performance.
- Provide input into the function's strategy.
- Lead people or projects.
Benefits
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Bonus incentive plan based on company and/or individual performance
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What This Job Offers
Job Type
Full-time
Career Level
Director
