Senior Hospital Contracting Strategist

Humana

6d • $78,400 - $107,800 • Remote

About The Position

The Senior Hospital Contracting Strategist / Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting. As the Senior Hospital Contracting Strategist/ Senior Provider Contracting Professional you will Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements. Extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership. Experience with Medicare Advantage, Medicaid, and value based-contracting. Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements. Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable. 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. Help with identifying and recruiting providers based on network composition and needs.

Requirements

• Bachelor's degree
• 5 or more years of Hospital negotiation experience in Medicare
• Leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
• Experienced in negotiating managed care contracts with Hospital systems inclusive of post acute, ancillary providers and physicians.
• Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.
• Understand and interpret Hospital contract language
• Proficient in Microsoft Office: Word, Excel and PowerPoint

Nice To Haves

• Master's Degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements
• Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable
• 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
• Help with identifying and recruiting providers based on network composition and needs

Benefits

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

What This Job Offers

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