Provider Contracting Network Rep

Humana

2d • $65,000 - $88,600 • Remote

About The Position

Become a part of our caring community and help us put health first The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital and/or other provider contracts and agreements for an organization that provides health insurance. Provider Contracting Professional 2 Actively communicates contract terms, payment structures, reimbursement rates to providers internal and external constituents Negotiating and maintaining contracts with hospital partners to ensure our network meets regulatory and business requirements. Managing relationships with key providers to support member access, minimize disruption, and maintain competitive advantage. Ensuring contract terms are implemented accurately and that our organization is protected from risk, both financially and legally. Supporting cross-functional teams with timely updates on contracting status, rate changes, and network developments. Managing these contract relationships with large statewide hospital systems requires the team to work with internal and external constituents on all areas of contracting; network management; adequacy and gaps; provider education; conflict resolution; claim escalation and research; compliance initiatives and grievances; joint operating committees; and all other facets of the business while also working closely with our Humana counterparts on enterprise initiatives. Use your skills to make an impact

Requirements

• 2 or more years of experience in negotiating managed care contracts with physician specialty, hospital and/or other provider contracts.
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Experience with public speaking and presentation skills

Nice To Haves

• Bachelor's degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in MS Office applications

Responsibilities

• Negotiating and maintaining contracts with hospital partners to ensure our network meets regulatory and business requirements.
• Managing relationships with key providers to support member access, minimize disruption, and maintain competitive advantage.
• Ensuring contract terms are implemented accurately and that our organization is protected from risk, both financially and legally.
• Supporting cross-functional teams with timely updates on contracting status, rate changes, and network developments.
• Managing these contract relationships with large statewide hospital systems requires the team to work with internal and external constituents on all areas of contracting; network management; adequacy and gaps; provider education; conflict resolution; claim escalation and research; compliance initiatives and grievances; joint operating committees; and all other facets of the business while also working closely with our Humana counterparts on enterprise initiatives.

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
• Number of Employees: 5,001-10,000 employees