[Hiring] Provider Contracting Professional @Humana

Role Description

The Provider Contracting Professional initiates, negotiates, and executes behavioral health provider contracts for South Carolina Medicaid.

• Communicates contract terms, payment structures, and reimbursement rates to Behavioral Health providers.
• Analyzes the financial impacts of contracts and terms.
• Maintains contracts and documentation within a tracking system.
• Identifies and recruits providers based on network composition and needs.
• Makes decisions on moderately complex issues regarding technical approaches for project components.
• Engages in contracting negotiations with Behavioral Health physicians and Community Mental Health providers.
• Exercises considerable latitude in determining objectives and approaches to assignments.

Qualifications

• 2+ years of experience in negotiating or servicing managed care contracts with physician, hospital and/or other provider contracts.
• Proficiency in analyzing, understanding, and communicating the financial impact(s) of contract terms, payment structures and reimbursement rates to providers.
• Must live within the market to include SC, NC, GA.

Requirements

• Bachelor's Degree (preferred).
• Experience with behavioral health contracts (preferred).
• Experience working with Medicaid contracts (preferred).

Benefits

• 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.
• Many other opportunities supporting whole-person well-being.