Senior Provider Contracting Professional- WAH TX

Profile

Description

The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. 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.

Responsibilities

The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers. 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.

Typical Responsibilities, but not limited to:

Negotiate position contracts within the Largest Medicare Network in the State of Texas; Contracting Dallas Ft. Worth and East Texas Markets

Implement negotiated contracts

Provide service to the providers within the network

Required Qualifications

Bachelor's degree

5 or more years of progressive network management experience this could include: hospital contracting or network administration in a healthcare company or a related area

Experienced in negotiating managed care contracts with large physician groups, or ancillary providers or hospital systems or related area

Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.

Ability to manage multiple priorities in a fast-paced environment

Proficiency in most MS Office applications (Excel, Outlook, PowerPoint, TEAMS)

Advanced in MS Word

Prior experience in contract review systems (templates)

Position does require travel to Dallas Office throughout the year (to be determined by leader)

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Master's Degree

Experience with ACO/Risk Contracting

Experience with Value Based Contracting

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com