Senior Provider Contracting Professional

Profile

Description

The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Contracting Professional 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. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

3 or more years of progressive network management experience including provider contracting and network administration in a healthcare company

Experienced in negotiating managed care contracts with large physician groups, ancillary providers and/or hospital systems.

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

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

Preferred Qualifications

Bachelor's Degree

Experience with ACO/Risk Contracting

Experience with Value Based Contracting

Additional Information

This position will be work at home, however, you will be required to travel to provider offices within the South Carolina Market up to 50% of the time.

Scheduled Weekly Hours

40

Company info

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