Senior Provider Contracting Professional - Behavioral Health/Medicaid

About the role

The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The role communicates contract terms, payment structures, and reimbursement rates to providers, provides a comprehensive hospital network to consumers in the behavioral health arena, and executes on Humana's consumer-focused business strategy. The Senior Provider Contracting Professional will negotiate with a variety of provider constituencies, provide continual re-prioritization of corporate and consumer needs, analyze financial impact of contracts and terms, and maintain contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Exercises considerable latitude in determining objectives and approaches to assignments.

Responsibilities

• Negotiate hospital and ancillary contracts at market competitive pricing
• Initiate and maintain productive long-term relationships with key hospital and group practice administrators and members
• Communicate proactively with other departments to ensure effective and efficient business results
• Handle services, levels of care, and pricing on the behavioral health network side
• Serve as subject matter expert on the assigned region/behavioral health network
• Manage large accounts and/or provider relations
• Engage in C-suite interactions, both internally and externally

Requirements

• 3-4 years of progressive network management experience including hospital contracting and network administration in a healthcare company or healthcare system
• Medicaid behavioral health contracting experience, to include contract negotiation
• Medicaid provider relations experience
• Experience negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems
• Proficiency in analyzing, understanding, and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers

Qualifications

• Bachelor's Degree (desired)
• Experience with ACO/Risk Contracting (desired)
• Experience with Value Based Contracting (desired)

Additional Information

This role is remote/work at home and can be based anywhere in the United States, with preference given to candidates located in the Eastern or Central Time Zone.

Work at home requirements:

• Self-provided internet service must meet the following criteria: at minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired cable or DSL connection is suggested
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled weekly hours: 40

Pay

The pay range for this role is $78,400 - $107,800 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits that 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