Provider Contracting Professional (Dental Network)
About the role
The Provider Contracting Professional (Dental Network) initiates, negotiates, and executes dental provider contracts and agreements for the organization. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
- Communicate contract terms, payment structures, and reimbursement rates to providers.
- Analyze financial impact of contracts and terms.
- Maintain contracts and documentation within a tracking system.
- Auxiliary tasks may include identifying and recruiting providers based on network composition and needs.
- Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
- Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed.
- Follow established guidelines/procedures.
- Prioritize leads, fee schedule reimbursement, needed travel for in-person dental office visits, research of local community events and how Humana can support these events, identification of local dental society sponsorship opportunities, and assisting providers with a variety of issues.
- Examples include; identifying which fee schedule to offer and also negotiating to determine the value of the provider to all Humana customers based on the compensation.
- Meet with Dental Providers face-to-face.
Qualifications
- 2 - 5 years of experience negotiating 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.
Preferred Qualifications
- Bachelor's degree.
- Master's Degree.
- Experience with ACO/Risk Contracting.
- Experience with Value Based Contracting.
Pay
$65,000 - $88,600 per year
Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.
About Us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.