Provider Contracting Director jobs in Florida

Provider Contracting Director is responsible for the operations of the provider contracts department. Ensures that provider contracts are processed to support accurate and efficient claims payments. Being a Provider Contracting Director oversees the formulation of provider contracts and specific terms. Analyzes contract data and provides financial projections. Additionally, Provider Contracting Director requires a bachelor's degree. Typically reports to top management. The Provider Contracting Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Provider Contracting Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

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Provider contracting
  • Humana
  • Boca Raton, FL FULL_TIME
  • 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

  • 1 Month Ago

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Provider contracting
  • Humana
  • Greenacres, FL FULL_TIME
  • 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...
  • 1 Month Ago

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Provider contracting
  • Humana
  • Clearwater, FL FULL_TIME
  • 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 an...
  • 1 Month Ago

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Senior Provider Contracting Professional
  • Humana
  • Tampa, FL FULL_TIME
  • Become a part of our caring community and help us put health first The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts...
  • 14 Days Ago

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Manager, Provider Services and Contracting
  • Independent Living Systems
  • Orlando, FL FULL_TIME
  • ABOUT USJoin us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiari...
  • 15 Days Ago

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Provider Contracting Professional 2
  • Humana
  • Fort Lauderdale, FL FULL_TIME
  • Become a part of our caring community and help us put health first The Provider Contracting Professional 2 initiates, negotiates, and executes primary care, skilled nursing, and/or other provider cont...
  • 1 Month Ago

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Logistics Provisioner Army Project
  • Conley & Associates, Inc
  • Harvey, LA
  • Job Description Job Description Job Description: Work in Powerlog creating a database as directed. Screen parts and comp...
  • 3/28/2024 12:00:00 AM

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Assistant Accountant (Provisional)
  • City of Buffalo, NY
  • Buffalo, NY
  • An incumbent to a position in this class performs professional accounting work of more than ordinary difficulty in maint...
  • 3/28/2024 12:00:00 AM

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Provisional Licensed Counselor
  • Christian Wellness Center Of NJ LLC
  • Somerset, NJ
  • Job Description Job Description Duties/Responsibilities: • Provide counseling for clients and patients, individually and...
  • 3/28/2024 12:00:00 AM

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Provisionally Licensed Clinician, LAC, LSW
  • Human Institute
  • Totowa, NJ
  • HUMAN INSTITUTE PSYCHOLOGY AND THERAPY Provisionally Licensed Clinician, LAC, LSW $35 to $45/hr Full-time or Part-time C...
  • 3/28/2024 12:00:00 AM

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Payroll Specialist (Provisional) CBO
  • Wayne-Finger Lakes BOCES
  • Newark, NY
  • Regional Support Center - Central Business Office $48,000-$60,000 This is a competitive position. Must meet requirements...
  • 3/27/2024 12:00:00 AM

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Clerk, Bilingual (Spanish) Provisional 10/23
  • Inc. Village of Hempstead
  • Hempstead, NY
  • The Village of Hempstead is seeking a candidate to be the Front Desk Receptionist who will provide information to the pu...
  • 3/27/2024 12:00:00 AM

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CNA/LPN On-call Provisional
  • College of St Benedict/St Johns University
  • Collegeville, MN
  • Position Summary Saint John's Abbey invites applications for the on-call positions of CNA and LPN in the Abbey Retiremen...
  • 3/24/2024 12:00:00 AM

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Licensed Psychotherapist ( Provisional or Fully Licensed)
  • Clinical Counseling and Consulting
  • Fayetteville, NC
  • Job Description Job Description We are seeking a Licensed Psychotherapist ( Provisional Or Fully Licensed) to join our t...
  • 3/24/2024 12:00:00 AM

Florida (/ˈflɒrɪdə/ (listen); Spanish for "land of flowers") is the southernmost contiguous state in the United States. The state is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Atlantic Ocean, and to the south by the Straits of Florida. Florida is the 22nd-most extensive (65,755 sq mi or 170,300 km2), the 3rd-most populous (21,312,211 inhabitants), and the 8th-most densely populated (384.3/sq mi or 148.4/km2) of the U.S. states. Jacksonville is the most populous municipality in the state and the largest city by area in th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Director jobs
$163,518 to $236,164

Provider Contracting Director in New Suffolk, NY
The partners expect that their efforts toward greater collaboration between mutuelles and private providers will contribute to greater financial risk protection of covered citizens and support access to universal health coverage.
January 02, 2020
Provider Contracting Director in Vincennes, IN
The provider of services can choose how to perform the service.
January 27, 2020
Provider Contracting Director in Wichita Falls, TX
The Credentialing Committee is chaired by our Medical Director and they give the final determination if a provider meets our credentialing criteria.
December 05, 2019