Provider Contracting Professional

Become a part of our caring community and help us put health first
 Humana Healthy Horizons is seeking a Provider Contracting Professional who initiates, negotiates, and executes physician, hospital, and other provider contracts and agreements related to Medicaid health plans. The Provider Contracting Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Provider Contracting Professional responsibilities include (but not limited to):

• 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.

Use your skills to make an impact
 

Required Qualifications

• Must work within the eastern standard time zone hours.
• 2+ years of experience in negotiating managed care contracts with physicians, hospitals and/or other provider contracts.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and work independently in a fast-paced environment.
• Moderate to advanced proficiency working with MS Office applications.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Bachelor's degree.
• Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Experience with New Network Management.
• Experience with QuickBase.
• 2+ years of network development and Medicaid/Medicare experience.

Additional Information:

• Workstyle: Remote, work at home.
• Travel: None.
• Core Workdays & Hours: Typically, Monday – Friday; 8:00am – 5:00pm Eastern Standard Time.
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....  

Interview Format

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