Senior Provider Contracting Professional
About The Position
The Senior Provider Contracting Professional in the Central Region initiates, negotiates, and executes physician, hospital, and other provider contracts and agreements for a health insurance organization. The role leads contracting activity for assigned markets, providers, provider types, and territory, and works with internal stakeholders to advance enterprise network strategy and organizational objectives. The professional develops provider relationships, resolves complex contractual and relationship issues, evaluates financial and operational impacts of contract terms, and supports value-based arrangements and quality rewards programs where applicable. The role ensures contracts comply with Humana policies, applicable regulations, and internal governance requirements, while collaborating with legal, finance, network operations, credentialing, provider engagement, and clinical leadership. This is a remote position with occasional travel to Humana offices for training or meetings. Employees working from home or a hybrid home/office arrangement must have a dedicated workspace protecting member PHI/HIPAA information and internet service with at least 25 Mbps download and 10 Mbps upload speeds.
Requirements
- Bachelor's degree.
- At least 5 years of progressive network management experience, including hospital contracting and network administration in a healthcare company.
- Experience negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems.
- Proficiency in analyzing, understanding, and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers.
- Proficiency in MS Office applications.
Nice To Haves
- Master's degree.
- Experience with ACO/Risk Contracting.
- Experience with Value Based Contracting.
Responsibilities
- Lead provider contracting activity for assigned markets, providers, and provider types within the assigned territory.
- Negotiate and execute provider agreements, amendments, renewals, and terminations in alignment with enterprise network strategy.
- Develop and maintain productive relationships with physician groups, ancillary providers, and hospitals.
- Resolve complex provider issues related to contract interpretation, escalations, and relationship management.
- Partner with internal stakeholders to ensure contracts support affordability, quality, network adequacy, growth, and member access objectives.
- Evaluate financial and operational impacts of proposed contract terms and reimbursement models.
- Support implementation of shared-savings value-based arrangements and quality rewards programs, where applicable.
- Ensure contract terms comply with Humana policies, state and federal regulations, and internal governance requirements.
- Collaborate with matrixed teams including legal, finance, network operations, credentialing, provider engagement, and clinical leadership.
Benefits
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Paid time off, company holidays, and personal holidays.
- Paid parental and caregiver leave.
- Short-term and long-term disability insurance.
- Life insurance.
- Bonus incentive plan based on company and/or individual performance.
- Other opportunities supporting whole-person well-being.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
