Location
Lima, OH, United States
Posted on
Mar 31, 2022
Profile
Job Information
Humana
Senior Provider Contracting Professional - OH Medicaid
in
Lima
Ohio
Description
The Senior Provider Contracting Professional initiates, negotiates, and executes behavioral health physician, hospital, and/or other provider contracts under the Ohio Medicaid program. 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.
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. Engages in complex contracting negotiations with Behavioral Health facility, physician, and Community Mental Health providers. Exercises considerable latitude in determining objectives and approaches to assignments. Travels to assigned provider contact offices to provide education and support.
Responsibilities
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
o Medical Benefits
o Dental Benefits
o Vision Benefits
o Health Savings Accounts
o Flex Spending Accounts
o Life Insurance
o 401(k)
o PTO including 7 paid holidays, two personal holidays, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
o And more
Required Qualifications
Bachelor's degree
5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
Behavioral health contract negotiation experience
Experienced in negotiating managed care contracts with large behavioral health groups, ancillary providers and hospitals.
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
Candidate must reside within the state of Ohio
Preferred Qualifications
Master's Degree
Experience with Medicaid contracting
Experience with ACO/Risk Contracting
Experience with Value Based Contracting
Additional Information
This position is remote/work at home, however, you must live within the State of Ohio to be considered for this role.
Work-At-Home Requirements
WAH 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
Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination or commit to testing protocols
*OR *
Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40
Company info
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