Director Provider Contracting

Profile

Description

Responsibilities

The Director, Provider Contracting initiates, negotiates, and executes physician, hospital, ancillary and/or other provider contracts and agreements for an organization that provides health insurance. The Director, Provider Contracting requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

The Director, Provider Contracting 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. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy. This role will lead a team of contractors, whose responsibility it will be to achieve annual goals. This role reports directly to the Regional VP, Provider Contracting and Engagement for Specialty, Hospital, Ancillary and Large Group.

Required Qualifications

Bachelor's Degree

10 or more years extensive provider contracting experience

Proven leadership experience, including teambuilding

Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies

Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Master's or J.D. Degree

Experience with ACO/Risk Contracting

Value based contracting experience

Additional Information

Travel expected up to 15%

South FL location ideal, but Georgia, South Carolina, or other southeast state okay, too

Open to WAH or hybrid

Scheduled Weekly Hours

40

Company info

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