Provider Contracting Representative

Provider Contracting Professional 2

Become a part of our caring community

The Provider Contracting Professional 2 initiates, negotiates, and executes ancillary contracts agreements (LTSS/HCBS) for an organization that provides health insurance. Your work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Communicate contract terms, payment structures, and reimbursement rates to providers.

Analyze financial impact of contracts and terms.

Maintain contracts and documentation within a tracking system.

May assist with identifying and recruiting providers based on network composition and needs.

Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Follow established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

Two (2) or more years of experience negotiating managed care contracts with physicians, hospitals and/or other healthcare provider contracts.

One (1) or more years of experience in Long-Term Services and Supports (LTSS).

Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.

Proficiency in MS Office applications.

Preferred Qualifications

Bachelor's degree.

Experience with ACO/Risk Contracting.

Experience with Value-based Contracting.

Additional Information

Workstyle: This is a remote position.

Travel: Up to 10% as-needed travel is required for team engagement meetings, healthcare conferences and may include travel outside your state of residence.

Typical Work Schedule: Monday Friday; 8:00am 5:00pm Eastern Time (ET) with some flexibility based on business needs.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range $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.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.