Senior Provider Contracting Professional - Behavioral Health​/Medicaid

Overview

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

The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, or other provider contracts and agreements. 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.

Humana Behavioral Health

WAH Remote (anywhere USA)

The Senior Provider Contracting Professional for Medicaid Behavioral Health communicates contract terms, payment structures, and reimbursement rates to providers. This is done by building new provider networks to support Medicaid new business development. The Senior Professional also analyzes the financial impact of contracts and terms and maintains contracts and documentation within a tracking system. Begin to influence department s strategy. Work is performed without direction.

• Negotiate hospital, ancillary, and physician contracts at market competitive pricing.

• Recruit new providers to Medicaid networks to support Humana s Medicaid business development

• Communicate with other departments to ensure efficient results.

• Subject matter expert on their assigned region or states on all things behavioral health networks

• Support team leadership in developing network recruitment strategy to meet business needs

Required Qualifications

• 3 or more years of progressive network management experience and network administration in a healthcare company

• Experienced in negotiating managed care contracts with large behavioral health physician groups, ancillary providers and/or hospitals

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

• Bachelor s Degree

• Experience with hospital contracting

• Experience with ACO/Risk Contracting

• Experience with Value-based Contracting

• Located in Eastern or Central Time Zone

• 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.

• 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.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees 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 employees 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.

40

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.

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)…