[Hiring] Senior Provider Contracting Professional @Humana

Role Description

The Senior Provider Contracting Professional in the Central Region initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting.

• Lead provider contracting activity for assigned markets, providers, and provider types within assigned territory.
• Negotiate and execute provider agreements, amendments, renewals, and terminations in alignment with enterprise network strategy.
• Develop and maintain productive relationships with physician, provider groups, ancillary providers, and hospitals.
• Resolve complex provider issues related to contract interpretation, escalations, and relationship management.
• Partner with internal stakeholders to ensure provider contracts support affordability, quality, network adequacy, growth, and member access objectives.
• Evaluate financial and operational impacts of proposed contract terms and reimbursement models.
• Support implementation of shared savings value-based arrangements and quality rewards programs, where applicable.
• Ensure contract terms comply with Humana policies, state and federal regulations, and internal governance requirements.
• Collaborate with matrixed teams including legal, finance, network operations, credentialing, provider engagement, and clinical leadership.

Qualifications

• Bachelor's degree.
• 5+ years of progressive network management experience including hospital contracting and network administration in a healthcare company.
• 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.

Requirements

• Master's Degree (Preferred).
• Experience with ACO/Risk Contracting (Preferred).
• Experience with Value Based Contracting (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.

Additional Information

• Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps required; wireless, wired cable or DSL connection suggested.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours: 40.
• Pay Range: $78,400 - $107,800 per year, eligible for a bonus incentive plan based on performance.