Provider Contracting Professional 2 - Hybrid/Home 30 Travel Hernando/Pasco Counties FL

Profile

Description

The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Provider Contracting Professional 2 communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

Bachelor's degree or 2 years MA (Medicare Advantage) experience in Network Contracting

2 years of experience in negotiating managed care contracts with physician, Ancillary and/or other provider contracts.

Medical Claim knowledge

Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.

Excellent written and verbal communication skills

Ability to manage multiple priorities in a fast-paced environment

Proficiency in MS Office applications - Word, PowerPoint, Excel, Access

COVID VACCINATION : Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

WORK AT HOME Requirements : Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

DRIVE REQUIREMENTS: This job is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits and requires running a Motor Vehicle Report as part of the background check process.

Preferred Qualifications

Bachelor's Degree

Experience with MA products

Experience with Value Based Contracting

Additional information

Schedule: Monday to Friday from 8 am to 5 pm ET.

Work Style Hybrid/Home - Associates Home office environment is their primary work location where the majority of their work week will be spent, but they will use Humana office space occasionally for collaboration and other face-to-face needs.

Training : 2-4 weeks and ongoing as necessary. From a Humana's office located at 4925 Independence Pkwy Tampa, Fl. 33634. Suite 100

Work Location: This is a Hybrid Home position which will occasionally be required to attend in person at a Humana's office located at 4925 Independence Pkwy Tampa, Fl. 33634. Suite 100

Travel: 30% Visiting Providers in Hernando and Pasco Counties - Florida

#LI-Remote

#LI-EM1

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com