Provider Contracting Professional
About The Position
Become a part of our caring community Join Humana in this dynamic role where your expertise will directly influence our provider network and guide organizational success. Reporting to the Provider Contracting Manager within the WI Medicaid Market, you will communicate contract terms, analyze financial impacts, maintain accurate documentation, and recruit providers to meet strategic needs. If you're passionate about making a meaningful difference in healthcare and excel in a collaborative environment, we encourage you to join us and help shape the future of our network. Key Responsibilities: Communicate contract terms, payment structures, and reimbursement rates to providers. Analyze financial impact of contracts and terms. Maintain contracts and documentation within a tracking system. Analyze the department's service utilization. Responsible for identifying and recruiting providers based on network composition and needs. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Use your skills to make an impact
Requirements
- Bachelor's degree OR in lieu of degree, 2 or more years in negotiating managed care contracts with physicians, hospitals and/or other provider contracts.
- 2 years of experience working with health care and/or long term care providers
- 1 year of experience working in or with health insurance, managed care, or long term care programs
- Reside in Wisconsin or a contiguous state (MN, IA, IL), with the ability to travel up to 15% in WI
- Experience managing multiple projects or tasks at the same time
Nice To Haves
- Proficiency in analyzing and communicating financial impact of contract terms, payment structures and reimbursement rates to providers
- Experience with Value Based Contracting
Responsibilities
- Communicate contract terms, payment structures, and reimbursement rates to providers.
- Analyze financial impact of contracts and terms.
- Maintain contracts and documentation within a tracking system.
- Analyze the department's service utilization.
- Responsible for identifying and recruiting providers based on network composition and needs.
- Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
