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 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.
- 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:
- Self-provided internet service with a 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
- Pay range: $78,400 - $107,800 per year (based on geographic location and individual qualifications such as skills, knowledge, experience, education, and certifications).
- 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.
- Additional opportunities and programs to support personal wellness and smart healthcare decisions.
About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery, offering Medicare Advantage health plans in Florida for over 23 years. CarePlus helps people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through tailored plans.
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company providing insurance services and healthcare services to millions, aiming to deliver care and service when needed.