Provider Contract Operations Specialist

Humana • Miami, FL

2d • $65,000 - $88,600 • Hybrid

About The Position

Become a part of our caring community and help us put health first The Provider Contract Operations Specialist/ Provider Contracting Professional 2 initiates, negotiates, and executes physician, and/or other provider contracts and agreements for an organization that provides health insurance. You will report to the Director Provider, Contracting. Provider Contract Operations Specialist / Provider Contracting Professional 2 you will Analyze financial impact of contracts and terms. Maintain contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Communicate contract terms, payment structures, reimbursement rates to providers internal and external members Negotiate and maintain contracts with MSO or primary care providers to ensure our network meets regulatory and business requirements. Manage relationships with key providers to support member access, minimize disruption, and maintain competitive advantage. Ensure contract terms are implemented and that our organization is protected from risk, both financially and legally. Support cross-functional teams with updates on contracting status, rate changes, and network developments. Use your skills to make an impact

Requirements

• 2 or more years of experience in negotiating or servicing HMO managed care contracts
• Proficiency in Understanding of contract terms, payment structures and reimbursement rates
• Experience with public speaking or presentation skills and with provider facing communication
• Experience with Value-based Contracting
• Proficiency in MS Office Word and Excel (IE pivot tables, formulas, v-look up)
• Live in Broward, Dade, Palm Beach County
• To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Bachelor's degree
• Experience with ACO / Risk Contracting
• Bilingual (English/Spanish)

Responsibilities

• initiates, negotiates, and executes physician, and/or other provider contracts and agreements for an organization that provides health insurance
• Analyze financial impact of contracts and terms
• Maintain contracts and documentation within a tracking system
• May assist with identifying and recruiting providers based on network composition and needs
• Communicate contract terms, payment structures, reimbursement rates to providers internal and external members
• Negotiate and maintain contracts with MSO or primary care providers to ensure our network meets regulatory and business requirements
• Manage relationships with key providers to support member access, minimize disruption, and maintain competitive advantage
• Ensure contract terms are implemented and that our organization is protected from risk, both financially and legally
• Support cross-functional teams with updates on contracting status, rate changes, and network developments

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level