Dental Network Provider Contracting Professional

Profile

Description

The Provider Contracting Professional 2 initiates, negotiates, and executes dental 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. Prioritization of leads, fee schedule reimbursement, needed travel for in person dental office visits, research of local community events and how Humana can support these events, identification of local dental society sponsorship opportunities and assisting providers with a variety of issues. Examples include; identifying which fee schedule to offer and negotiating to determine the value of the provider to all Humana customers based on the compensation. Meet with Dental Providers face to face.

Required Qualifications

Bachelor's degree or equivalent work experience.

2 - 5 years of experience in negotiating managed care contracts with dentist, DSO, and dental practice managers.

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

Travel is required for this role to visit Dental Provider offices once COVID restrictions have been lifted - 3 days per week or as necessary. Travel could be regionally and some air travel might be necessary. Overnight travel may be necessary.

This role 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 100,000/300,000/100,000 limits.

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Preferred Qualifications

Master's Degree

Experience with ACO/Risk Contracting

Experience with Value Based Contracting

Additional Information

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

In addition, this position is considered a Field position - you will be required to work in the Field and travel to visit Dental Providers, once COVID restrictions have been lifted.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Company info

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