Senior Provider Contracting Professional

Humana, Inc.; Missouri; Hybrid; USD 78,000 - 108,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana, Inc. is seeking a Senior Provider Contracting Professional to lead and execute physician, hospital, and other provider contracts in the Central Region.

You will negotiate terms, renewals, and terminations while aligning with network strategy and affordability goals. You will build relationships with physician groups, hospitals and ancillary providers, analyze financial impact, collaborate with legal, finance and operations, and ensure compliance with policies and regulations.

Qualifications

• Bachelor's degree required.
• 5+ years of progressive network management experience including hospital contracting and network administration.
• Experience negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems.
• Ability to analyze and communicate financial impact of contract terms and reimbursement rates.

Responsibilities

• Lead provider contracting activity for assigned markets, providers and provider types.
• Negotiate and execute provider agreements, amendments, renewals, and terminations.
• Build relationships with physicians, provider groups, ancillaries and hospitals.
• Resolve complex provider issues related to contract interpretation and relationship management.
• Collaborate with stakeholders to ensure contracts support affordability, quality, network adequacy, growth and member access.
• Evaluate financial and operational impacts of proposed contract terms and reimbursement models.
• Support value-based arrangements and quality rewards programs where applicable.
• Ensure contracts comply with Humana policies and regulations.

Skills

Contract negotiation

Financial analysis

Provider contracts

MS Office

Education

Bachelor's degree

Master's degree

Tools

MS Office

Job description

Become a part of our caring community

The Senior Provider Contracting Professional in the Central Region initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting.

Key Responsibilities

Lead provider contracting activity for assigned markets, providers, and provider types within assigned territory.

Negotiate and execute provider agreements, amendments, renewals, and terminations in alignment with enterprise network strategy.

Develop and maintain productive relationships with physician, provider groups, ancillary providers and hospitals.

Resolve complex provider issues related to contract interpretation, escalations, and relationship management.

Partner with internal stakeholders to ensure provider 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 shares 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.

Use your skills to make an impact.

Required Qualifications

• Bachelor's degree
• 5+ years of progressive network management experience including hospital contracting and network administration in a healthcare company
• Experienced in negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures, and reimbursement rates to providers
• Proficiency in MS Office applications

Preferred Qualifications

• Master's Degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting

Additional Information

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.

$78,400 - $107,800 per year. This 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large.

Learn more about what we offer atHumana.comand atCenterWell.com.

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.