Provider Contracting Professional

Humana; Orlando (FL); Hybrid; USD 65,000 - 89,000; Full time

Job summary

Join Humana’s mission to improve health through effective provider network management. This role focuses on developing and maintaining relationships with providers under the TRICARE program, ensuring compliance with government contracts while optimizing the network's efficiency. The ideal candidate will hold a Bachelor's degree and possess significant experience in provider relations and negotiations.

Benefits

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off including holidays and volunteer time

Short and long-term disability

Life insurance

Qualifications

• 1 or more years of provider/customer relations experience or 3 years if non-degreed.
• Must be able to work 8-5 p.m. in the central or eastern time zone.
• Previous experience in provider contracting and/or negotiation.

Responsibilities

• Develop and maintain a cost-effective provider network in required PSAs.
• Participate in market network collaboration meetings for TRICARE.
• Ensure accurate initial contract packages from newly contracted providers.

Skills

Provider relations experience

Negotiation skills

Customer relations experience

Education

Bachelor's degree

Job description

Become a part of our caring community and help us put health first

Establish and maintain an appropriate and viable network of providers throughout their assigned prime service areas (PSAs) for TRICARE. Target providers for inclusion in the network based on network development strategy and complete contracts including the negotiation of discount rates. Develop and implement a renegotiation strategy to ensure HUMANA GOVERNMENT BUSINESS meets or exceeds the discount guarantee.

KEY ACCOUNTABILITIES -

• Develop and maintain a cost effective provider network in the required PSAs. Requirements include achieving budgeted discount percentages and network size to satisfy our network goals for new and existing providers

• Participate in market network collaboration meetings in order to foster greater understanding of the TRICARE program and improve cost awareness.

• Ensure that newly contracted providers submit accurate initial contract packages.

Use your skills to make an impact

Required Qualifications

• Our Department of Defense Contract requires U.S. citizenship for this position

• Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.

• Bachelor's degree and 1 or more years provider/customer relations experience. If non degreed must have 3 years or more of provider/customer relations experience.

• Must be able to work 8 - 5 p.m. in the central or eastern time zone

• Previous experience in provider contracting and/or negotiations/sales

Preferred Qualifications

• Knowledge of the TRICARE program and other Government contracting experience as well as the different reimbursement methodologies being employed.

• 2 or more years experience dealing with managed care or insurance issues (i.e. benefits, claims, etc.)

Work-At-Home Requirements

To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates 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 associates 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

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $88,600 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.