Senior Hospital Contracting Strategist (Remote)

Humana Inc; Jackson (MS); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Senior Hospital Contracting Strategist to initiate, negotiate, and execute hospital and other provider contracts for our health plans.

This remote role collaborates with cross-functional teams to ensure contracts are financially sound and operationally executable. The ideal candidate has 5+ years in hospital negotiations, strong experience with Medicare Advantage/Medicaid, and a track record in value-based contracting, reimbursement methods, and network management.

Qualifications

• Bachelor's degree required in a related field.
• 5+ years of Hospital negotiation experience in Medicare.
• 5+ years of progressive network management experience including hospital contracting and network administration in a healthcare company.
• Experience 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 negotiations

Contract negotiation

Provider network management

Reimbursement methodologies

Medicare/Medicaid knowledge

Microsoft Office

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Humana Inc. is seeking a Senior Hospital Contracting Strategist to initiate, negotiate, and execute hospital and other provider contracts for our health plans.

This remote role collaborates with cross-functional teams to ensure contracts are financially sound and operationally executable. The ideal candidate has 5+ years in hospital negotiations, strong experience with Medicare Advantage/Medicaid, and a track record in value-based contracting, reimbursement methods, and network management.