Provider Contracting Network Rep

Become a part of our caring community and help us put health first

The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance.

• Actively communicates contract terms, payment structures, reimbursement rates to providers internal and external constituents.
• Negotiates and maintains contracts with hospital partners to ensure our network meets regulatory and business requirements.
• Manages relationships with key providers to support member access, minimize disruption, and maintain competitive advantage.
• Ensures contract terms are implemented accurately and that our organization is protected from risk, both financially and legally.
• Supports cross-functional teams with timely updates on contracting status, rate changes, and network developments.
• Manages these contract relationships with large statewide hospital systems requiring teamwork on all areas of contracting; network management; adequacy and gaps; provider education; conflict resolution; claim escalation and research; compliance initiatives and grievances; joint operating committees; and all other facets of the business while also working closely with our Humana counterparts on enterprise initiatives.

• 2 or more years of experience in negotiating managed care contracts with physician specialty, hospital and/or other provider contracts.
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Experience with public speaking and presentation skills.

• Bachelor's degree.
• Experience with ACO/Risk Contracting.
• Experience with Value Based Contracting.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in MS Office applications.

• Travel to provider‑facing meetings as needed based on business needs.
• Hours – 8am to 5pm EST.

• 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.
• Associates 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 associates 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.

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third‑party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision‑making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre‑recorded Voice Interview and/or an SMS Text Messaging interview.

If participating in a pre‑recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10‑15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5‑10 minutes.

Your recorded interview(s) via text and/or pre‑recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

40

$65,000 – $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole‑person well‑being. Associate…