Provider Contracting Professional (Behavioral Health/Medicaid)

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About the role

The Provider Contracting Professional initiates, negotiates, and executes behavioral health provider contracts for South Carolina Medicaid. This role communicates contract terms, payment structures, and reimbursement rates to Behavioral Health providers, analyzes the financial impacts of contracts and terms, and maintains contracts and documentation within a tracking system. The position identifies and recruits providers based on network composition and needs, makes decisions on moderately complex issues regarding technical approaches for project components, and engages in contracting negotiations with Behavioral Health physicians and Community Mental Health providers. Exercises considerable latitude in determining objectives and approaches to assignments.

Responsibilities

• Initiate, negotiate, and execute behavioral health provider contracts for South Carolina Medicaid.
• Communicate contract terms, payment structures, and reimbursement rates to Behavioral Health providers.
• Analyze the financial impacts of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Identify and recruit providers based on network composition and needs.
• Make decisions on moderately complex issues regarding technical approaches for project components.
• Engage in contracting negotiations with Behavioral Health physicians and Community Mental Health providers.

Requirements

• 2+ years of experience in negotiating or servicing managed care contracts with physician, hospital, and/or other provider contracts.
• Proficiency in analyzing, understanding, and communicating the financial impact(s) of contract terms, payment structures, and reimbursement rates to providers.
• Must live within the market to include SC, NC, or GA.

Qualifications

• Bachelor's Degree (preferred).
• Experience with behavioral health contracts (preferred).
• Experience working with Medicaid contracts (preferred).

Work Environment

This role is "remote/work at home," however, you must live within the stated region (SC, NC, GA).

• Work at Home Requirements: Self-provided internet service must meet the following criteria: 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.
• Occasional travel to Humana's offices for training or meetings may be required.

Schedule

Scheduled Weekly Hours: 40

Pay

The pay range reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The range may vary based on geographic location and individual pay will depend on demonstrated job-related skills, knowledge, experience, education, and certifications.

$65,000 - $88,600 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive 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.