Remote Hospital Contracting Strategy Lead

Humana Inc; Cheyenne (WY); On-site; USD 78,000 - 108,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. seeks a Senior Hospital Contracting Strategist/Senior Provider Contracting Professional to lead hospital and health system contract negotiations, including reimbursement terms, amendments, renewals and value-based arrangements.

The role reports to the Director, Provider Contracting and is remote with occasional travel to Humana offices. You will assess reimbursement methods (DRG, Case Rates), analyze financial impact, and work with Finance, Legal, Network Management and Operations to

Qualifications

• Bachelor's degree required.
• 5+ years of Hospital negotiation experience in Medicare.
• Leading negotiations for hospital and health system agreements, including reimbursement, amendments, renewals and value based agreements.
• 5+ 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.

Responsibilities

• 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.

Skills

Hospital negotiation

Contract negotiations

Value-based contracting

Reimbursement methodologies

Financial analysis

Provider relationship management

Leadership

Education

Bachelor's degree

Master's degree (preferred)

Tools

Microsoft Office

Job description

Humana Inc. seeks a Senior Hospital Contracting Strategist/Senior Provider Contracting Professional to lead hospital and health system contract negotiations, including reimbursement terms, amendments, renewals and value-based arrangements.

The role reports to the Director, Provider Contracting and is remote with occasional travel to Humana offices. You will assess reimbursement methods (DRG, Case Rates), analyze financial impact, and work with Finance, Legal, Network Management and Operations to