Provider contracting

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

The Provider Contracting Professional 2 initiates, negotiates, and executes LTC provider contracts and agreements for an organization that provides LTC health insurance.

The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Network relationship management, including, but not limited to : Quality, Payment, Provider Experience, Financial Performance, Industry Trends, Legislative changes, AHCA contract requirements.

Implement and execute Network initiatives and strategic goals for network adequacy, contracting payment initiatives and AHCA compliance.

Identify and support new trends and savings opportunities related to network. Oversight of provider education / training, ensure trainings support provider needs and required by new AHCA contract.

Build and support provider association relationships. Work with clinical leaders to address concerns and ensure enrollees have appropriate access to providers.

The Provider Contracting Professional 2 communicates contract terms, payment structures, and reimbursement rates to providers.

Analyzes financial impact of contracts and terms.

Role Overview :

• Understands alternate payment structures and quality incentives for LTC providers. Maintains contracts and documentation within a tracking system.
• May assist with identifying and recruiting providers based on network composition and needs.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines / procedures.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree OR 2 years of experience in negotiating contracts in a client facing role.
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Navigate and utilize multiple programs / systems (CRM systems specifically)
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in MS Office applications, advanced level Excel experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Able to travel 40% of the time throughout Palm Beach County, Florida

Preferred Qualifications

• Master's Degree
• Adobe Sign experience
• Experience with Value Based Contracting

Work-At-Home Requirements

To ensure Home or Hybrid Home / Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home / Office associates 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
• 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

Travel

• This position will require a minimum of 40% travel to Palm Beach County, FL
• Must have a Valid driver’s license with reliable transportation and the ability to travel within the state, as required
• This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000 / 300,000 / 100,000 limits.

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 an email correspondence inviting you to participate in a pre-recorded Voice Interview and / or an SMS Text Messaging interview.

please be sure to check your spam or junk folders often to ensure communication isn’t missed) 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 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.

Scheduled Weekly Hours

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.

Last updated : 2024-02-25