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.
Assignment: Humana Behavioral Health
The Senior Provider Contracting Professional for SC Medicaid communicates contract terms, payment structures, and reimbursement rates to providers. Providing a comprehensive hospital network to consumers in the behavioral health arena and executing on Humana’s consumer-focused business strategy demands constant negotiation with a variety of provider constituencies and continual re-prioritization of corporate and consumer needs. 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. In this role you will:
* Negotiate hospital and ancillary contracts at market competitive pricing.
* Initiate and maintain productive long-term relationships with key hospital and group practice administrators and members.
* Communicate proactively with other departments in order to ensure effective and efficient business results.
* You will handle services and levels of care and pricing on the behavioral health network side
* Subject matter expert on their assigned region or states on all things behavioral health networks
* Manage large accounts and/or provider relations
* Associate management oversight of 3-5 direct reports
* C-suite interactions both internally and externally
* 3-4 years of progressive network management experience including hospital contracting and network administration in a healthcare company or healthcare system
* Medicaid behavioral health contracting experience
* Medicaid provider relations experience (face to face provider visits required
* Experienced in negotiating managed care contracts with large physician groups, ancillary providers and 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
* Previous leadership experience and oversight of Associates
* Ability to have difficult conversations with individuals at all levels of the organization internally and externally
* Ability to manage regional accounts
* Ability to adapt well when utilizing multiple new systems
* Strong negotiation skills
* Behavioral health contracting experience
* Bachelor’s Degree
* Experience with ACO/Risk Contracting
* Experience with Value Based Contracting
This position is “remote/work at home”, however, you must live within the state of South Carolina in order to be considered for this opportunity.
Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Scheduled Weekly Hours