Senior Hospital Contracting Strategist

Become a part of our caring community as a Senior Hospital Contracting Strategist / Senior Provider Contracting Professional. You will initiate, negotiate, and execute physician, hospital, and other provider contracts and agreements for a health insurance organization, reporting to the Director of Provider Contracting.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value-based agreements.
• 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 the 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.
• 5 or more years of progressive network management experience, including hospital contracting and network administration in a healthcare company.
• Experience negotiating managed care contracts with hospital systems, including post-acute, ancillary providers, and physicians.
• Ability to analyze, understand, and communicate the financial impact of contract terms, payment structures, and reimbursement rates to providers.
• Proficiency in interpreting hospital contract language.
• Proficient in Microsoft Office: Word, Excel, and PowerPoint.

Preferred Qualifications

• Master’s degree.
• Experience with ACO/Risk Contracting.
• Experience with Value-Based Contracting.
• Extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership.
• Experience with Medicare Advantage, Medicaid, and value-based contracting.

Schedule

• 8 AM to 5 PM EST.
• Scheduled weekly hours: 40.
• Travel based on business needs; occasional travel to Humana's offices for training or meetings may be required.

Work at Home Requirements: To ensure effective remote work, your 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 suggested). Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Pay

The pay range for this full-time position (40 hours per week) is $78,400 - $107,800 per year. The range may vary based on geographic location, and individual pay will depend on demonstrated job-related skills, knowledge, experience, education, and certifications. This role is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits designed to 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 other opportunities.