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.

Schedule

• Scheduled weekly hours: 40.
• Standard work hours: 8 AM to 5 PM EST.
• 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 (full-time, 40 hours per week).
• 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 (paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.