Senior Provider Contracting Professional (Behavioral Health / Medicaid)

Senior Provider Contracting Professional

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 Behavioral Health contracts and agreements within the Virginia Medicaid space. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers in building and maintaining Medicaid Behavioral Health provider networks. Analyzes the financial impact(s) of contracts and terms. Maintains contracts and documentation within a tracking system. Will assist with identifying and recruiting providers based on network composition and needs. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components and work is performed with minimal direction.

Required Qualifications :

• 3-5 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
• Experience with Behavioral Health contracts
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in MS Office applications
• Must live within reasonable driving distance to the state of Virginia

Preferred Qualifications :

Additional Information :

This role is considered "remote / work at home", however, you must live within reasonable driving distance to the State of Virginia to be considered for this opportunity.

Work at Home Information :

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. 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 : 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 : The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and / or individual performance.

Description of Benefits : Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us : Humana Inc. 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 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services.