Responsibilities
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, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Required Qualifications
3 or more years of progressive network management experience including network administration in a healthcare company
Experienced in negotiating managed care contracts with large physician groups and ancillary providers
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
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must have a valid driver’s license with reliable transportation and the ability to travel within the region up to 20% of the time
Preferred Qualifications
Bachelor’s degree
Experience with ACO/Risk Contracting
Experience with Value Based Contracting
Additional Information
This position is considered a remote opportunity, however, you must live in the Upstate New York region as you will be required to travel to providers within this region.
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 10×1 (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:
Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40