Director, Provider Contracting

About the role

The Director, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. The Director, Provider Contracting negotiates contract terms, payment structures, and reimbursement rates to providers across the state for both Medicare Advantage and Medicaid products. Able to work with detailed analytics to understand and communicate financial impact of contracts and terms. Works within multiple systems and tools to maintain contracts and contract details. Leads efforts with identifying and recruiting providers based on network composition and needs. Engagement and decision-making responsibilities related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes. Implements strategic plans, drives goals and objectives, supports operational improvement efforts, and improves performance. Leads contracting team and drives provider relationship.

Responsibilities

• Initiate, negotiate, and execute physician, hospital, and/or other provider contracts and agreements
• Negotiate contract terms, payment structures, and reimbursement rates for Medicare Advantage and Medicaid products
• Work with detailed analytics to understand and communicate financial impact of contracts and terms
• Maintain contracts and contract details within multiple systems and tools
• Lead efforts to identify and recruit providers based on network composition and needs
• Engage in decision-making related to implementation of new/updated programs or large-scale projects
• Support technical/operational procedures and processes
• Implement strategic plans, drive goals and objectives, and support operational improvement efforts
• Lead contracting team and drive provider relationships

Required Qualifications

• Bachelor's Degree
• Extensive provider contracting experience
• Proven leadership experience, including teambuilding
• Proven contract preparation skills with in-depth knowledge of Medicare and other reimbursement methodologies
• Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
• Must live within reasonable driving distance to the State of South Carolina and be willing and able to travel within the region, on occasion

Preferred Qualifications

• Master's or J.D. Degree
• Experience with ACO/Risk Contracting
• Value based contracting experience

Work Location & Travel

This role is remote/work at home, however, you must live within or in close proximity to the State of South Carolina. Minimal travel is expected, likely for team meetings or in-person provider meetings. Occasional travel to Humana's offices for training or meetings may be required.

Work at Home Requirements

To ensure effective work, the self-provided internet service must meet the following criteria: a minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable or DSL connection is suggested. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Humana reserves the right to require associates to upgrade their internet service if necessary.

Pay

$138,900 - $191,000 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Schedule

Scheduled Weekly Hours: 40

Benefits

Humana offers benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.