Provider Contracting Professional (Behavioral Health/Medicaid)

Humana; North (SC); Remote; USD 65,000 - 89,000; Full time

Job summary

A leading healthcare company seeks a Provider Contracting Professional to manage behavioral health provider contracts. You will negotiate contract terms, analyze financial impacts, and recruit providers. Ideal candidates have over 2 years of relevant experience and must live near Virginia. This remote role requires strong communication skills and the ability to manage multiple priorities in a fast-paced environment.

Benefits

Competitive medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Life insurance

Qualifications

• 2+ years of experience in negotiating or servicing managed care contracts.
• Ability to communicate the financial impacts of contract terms.
• Must live within reasonable driving distance to Virginia.

Responsibilities

• Communicates contract terms and reimbursement rates to providers.
• Analyzes financial impacts of contracts and maintains documentation.
• Identifies and recruits providers based on network needs.

Skills

Negotiation Skills

Financial Analysis

Communication Skills

MS Office Proficiency

Multitasking

Education

Bachelor's Degree

Job description

Overview

Become a part of our caring community and help us put health first. The Provider Contracting Professional initiates, negotiates, and executes behavioral health provider contracts for Virginia Medicaid. The Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to Behavioral Health providers. Analyzes the financial impacts of contracts and terms. Maintains contracts and documentation within a tracking system. Identifies and recruits providers based on network composition and needs. Makes decisions on moderately complex issues regarding technical approaches for project components. Engages in contracting negotiations with Behavioral Health physicians and Community Mental Health providers. Exercises considerable latitude in determining objectives and approaches to assignments.

Responsibilities

• Communicates contract terms, payment structures, and reimbursement rates to Behavioral Health providers.
• Analyzes financial impacts of contracts and terms.
• Maintains contracts and documentation within a tracking system.
• Identifies and recruits providers based on network composition and needs.
• Participates in contracting negotiations with Behavioral Health physicians and Community Mental Health providers.
• Makes decisions on moderately complex issues regarding technical approaches for project components.

Required Qualifications

• 2+ years of experience in negotiating or servicing managed care contracts with physician, hospital and/or other provider contracts.
• Proficiency in analyzing, understanding, and communicating the financial impact(s) of contract terms, payment structures and reimbursement rates to providers.
• Excellent written and verbal communication skills.
• Proficiency in MS Office applications.
• Ability to manage multiple priorities in a fast-paced environment.
• Must live within reasonable driving distance to the Virginia market.

Preferred Qualifications

• Bachelor's Degree.
• Experience with behavioral health contracts.
• Experience working with Medicaid contracts.

Additional Information

• This role is remote/work at home; however, you must live within reasonable driving distance to the State of Virginia to be considered for this opportunity.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Work-at-Home Requirements

• Home or Hybrid Home/Office employees must have internet service meeting minimum criteria: download speed at least 25 Mbps and upload speed at least 10 Mbps; options include wireless, wired cable, or DSL.
• Satellite, cellular and microwave connections can be used only if approved by leadership.
• Humana provides necessary telephone equipment to meet business requirements.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• A minimum standard speed of 25x10 (25 Mbps download x 10 Mbps upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.

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Schedule and Compensation

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

Scheduled Weekly Hours: 40

Pay Range: $65,000 - $88,600 per year. The compensation range reflects a good faith estimate of starting base pay for full-time employment and may vary based on geographic location and demonstrated job-related skills, knowledge, experience, education, certifications, etc. This role is eligible for a bonus incentive plan based on company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries offer competitive benefits to support whole-person well-being, including medical, dental, and vision benefits, a 401(k) retirement savings plan, time off (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

Humana does not 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. Humana also takes affirmative action in compliance with applicable laws to employ and advance individuals with disabilities or protected veterans, and to base all employment decisions on valid job requirements.