Senior Provider Contracting Professional - Behavioral Health/Medicaid
$78,400–$107,800 year
RemoteUnited States
Job Summary
Negotiate hospital and ancillary contracts at market competitive pricing while initiating and maintaining productive long-term relationships with key hospital and group practice administrators. Execute physician, hospital, and provider agreements for the behavioral health network, communicating terms, payment structures, and reimbursement rates to ensure effective business results. Analyze financial impacts of contract terms and manage large accounts, exercising considerable latitude in determining objectives and approaches. Subject matter expert on the assigned region, you will occasionally travel to Humana offices for training or meetings. This role supports Humana's consumer-focused strategy by providing a comprehensive hospital network to consumers in the behavioral health arena.
Required Qualifications
- 3-4 years of progressive network management experience including hospital contracting and network administration in a healthcare company or healthcare system
- Medicaid behavioral health contracting experience, to include contract negotiation
- Medicaid provider relations experience
- Experienced in negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems
- Proficiency in analyzing, understanding, and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers
- This role is remote/work at home and can be based anywhere in the United States, however, preference will be given to candidates that are located in the Eastern or Central Time Zone
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
- While this is a remote position, occasional travel to Humana's offices for training or meetings may be required
Desired Qualifications
- Bachelor's Degree
- Experience with ACO/Risk Contracting
- Experience with Value Based Contracting
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