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Provider Contracting Professional 2

Humana

Humana

Florida, USA · Remote
Posted on Thursday, July 6, 2023

Description

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+ years of experience in negotiating or servicing managed care 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 25x10 (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

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Scheduled Weekly Hours

40