Humana Looking For Provider Contracting Professional 2 at Saint Augustine, FL Full Time

The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

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. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

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

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 (Word, Excel)

Ability and willingness to travel to provider offices within the Northeast Florida region up to 30% of the time

Preferred Qualifications

Bachelor’s Degree

Working knowledge of HEDIS

Experience with Value Based Contracting

Additional Information

This role is considered “remote/work at home”, however, you will be responsible for the Flagler and St John’s Counties and therefore, must live within the Northeast region of Florida to be considered for this role.

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 25×10 (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

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of COVID-19 vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Not Specified

0