Provider Contracting Representative

About the role

Initiates, negotiates, and executes ancillary contracts agreements (LTSS/HCBS) for an organization that provides health insurance. Your work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• 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.
• May assist with identifying and recruiting providers based on network composition and needs.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Follow established guidelines/procedures.

Requirements

• Two (2) or more years of experience negotiating managed care contracts with physicians, hospitals and/or other healthcare provider contracts.
• One (1) or more years of experience in Long-Term Services and Supports (LTSS).
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Proficiency in MS Office applications.

Preferred Qualifications

• Bachelor's degree.
• Experience with ACO/Risk Contracting.
• Experience with Value-based Contracting.

Workstyle

This is a remote position.

Travel

Up to 10% as-needed travel is required for team engagement meetings, healthcare conferences and may include travel outside your state of residence. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Schedule

Monday – Friday; 8:00am – 5:00pm Eastern Time (ET) with some flexibility based on business needs.

Scheduled Weekly Hours: 40

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Pay

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

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Benefits

Humana offers competitive benefits that support whole-person well-being. 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
• Many other opportunities