Job Information
Humana Senior Provider Contracting Professional in Columbia, South Carolina
Become a part of our caring community and help us put health first
The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for Humana's Behavioral Health business. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Provider Contracting Professional for Behavioral Health/Medicaid communicates contract terms, payment structures, and reimbursement rates to providers. Providing a comprehensive hospital network to consumers in the behavioral health arena and executing on Humana's consumer-focused business strategy demands constant negotiation with a variety of provider constituencies and continual re-prioritization of corporate and consumer needs. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. In this role you will:
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.
Ability to have difficult conversations with individuals at all levels of the organization internally and externally
Ability to adapt well when utilizing multiple new systems
Communicate proactively with other departments in order to ensure effective and efficient business results.
You will handle services and levels of care and pricing on the behavioral health network side
Subject matter expert on their assigned region or states on all things behavioral health networks
Manage large accounts and/or provider relations
Will manage regional accounts
Associate management oversight of 3-5 direct reports
C-suite interactions both internally and externally
Function independently and/or with limited direction on projects
Manage multiple priorities in a fast-paced environment
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Parental and caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities
Use your skills to make an impact
Required Qualifications
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
Medicaid provider relations experience (face to face provider visits required)
Experience with Community Mental Health Centers and their services
Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems.
Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
Proficiency in MS Office applications
Ability to understand basic billing guidelines for various Medicaid states
Occasional travel to providers within the region
Preferred Qualifications
Bachelor's Degree
Experience with ACO/Risk Contracting
Experience with Value Based Contracting
Additional Information
This position is considered "remote/work at home" however, you must be within driving distance to South Carolina and be willing and able to travel within the region, on occasion.
Work at Home Information
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$76,800 - $105,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.