Provider Contracting Executive
Remote US
The Provider Contracting Executive will be building and servicing hospital networks from the ground up with little direction. In this role, you will initiate, negotiate, and execute physician, ancillary, and/or other provider contracts and agreements for Virginia Medicare and Medicaid providers. The Provider Contracting Executive's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
- The Provider Contracting Executive negotiates and communicates contract terms, payment structures, and reimbursement rates to providers that are aligned with Humana's financial strategies
- Maintains contracts and documentation within a tracking system
- Identifies and recruits providers based on network composition and needs
- Advises executives to develop functional strategies (often segment specific) on matters of significance
- Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision
- Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
Use your skills to make an impact
Required Qualifications
5 or more years of progressive network management experience working with hospitals, facilities and other large provider practices on recruitment and service activities
Experienced in negotiating or servicing managed care contracts with large physician groups, ancillary providers and hospitals
Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
Experience with Medicaid Contracting
Experience with ACO/Risk Contracting
Excellent written and verbal communication skills
Proficiency in MS Office applications
Preferred Qualifications
Advanced degree (Bachelor's, Master's, JD)
Experience with Value Based Contracting
Additional Information
This position is considered "remote/work at home", however, the preferred candidate will live within driving distance to providers within the State of Virginia.
- WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live …
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Dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Remote US Virginia
Benefits/Perks401(k) with match Bonus Incentive Bonus incentive plan Career development Career development opportunities Caring community Competitive benefits Dental Employee charity matching Employee charity matching program Health benefits Health benefits effective day 1 Holidays Life Insurance Medical Paid parental and caregiver leave Paid Time Off Parental and Caregiver Leave Personal holidays Recognition pay Scholarships Scholarships for eligible dependents Time off Tuition Assistance Vision Vision Benefits Volunteer time Volunteer time off Work From Home
Tasks- Communication
- Decision making
- Develop functional strategies
- Documentation
- Negotiate contracts
- Training
Analysis Analyzing Communication Compensation Contracting Contract Negotiation Data Decision making Documentation Financial analysis Healthcare HIPAA Managed Care Medicaid Medicare MS Office Negotiating Network Network management Provider Contracting Recruitment Security Training Verbal communication Wellness
Experience5 years
EducationAdvanced degree Associates Bachelor's Communication Education Healthcare J.D. Management Master's MS
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9