Provider Contracting Professional 2

Profile

Description

The Provider Contracting Professional 2 initiates, negotiates, and executes physician 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. This role is responsible for educating network providers on policies and procedures for Humana plans.

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. The role also provides education to the provider network related to Humana operations and resolution of service issues.

Required Qualifications

2 - 5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts.

1 years experience with Louisiana Medicaid.

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

Scheduled Weekly Hours

40

Company info

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