Senior Hospital Contracting Strategist

About the role

Become a part of our caring community. The Senior Hospital Contracting Strategist / Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting. As the Senior Hospital Contracting Strategist/ Senior Provider Contracting Professional you will lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value‑based agreements.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• Apply extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership
• Work with Medicare Advantage, Medicaid, and value‑based contracting
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements
• Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable
• 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
• Help identify and recruit providers based on network composition and needs

Requirements

• Bachelor’s degree
• 5 or more years of hospital negotiation experience in Medicare
• Experience leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
• Experienced in negotiating managed care contracts with hospital systems inclusive of post‑acute, ancillary providers and physicians
• Ability to analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers
• Ability to understand and interpret hospital contract language
• Proficient in Microsoft Office: Word, Excel and PowerPoint

Qualifications

• Master’s Degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting

Benefits

• 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 supporting whole‑person well‑being

Pay

$78,400 - $107,800 per year (eligible for a bonus incentive plan based on company and/or individual performance)

Schedule

• Standard hours: 8am to 5pm EST
• Scheduled weekly hours: 40
• Occasional travel to Humana's offices for training or meetings may be required
• Work‑from‑home requirements: minimum download speed 25 Mbps, upload speed 10 Mbps (wireless, wired cable or DSL suggested); dedicated workspace free of ongoing interruptions to protect member PHI/HIPAA information