Job Information
Humana Senior Provider Contracting Professional in Irvine, California
Description
The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Senior Based 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.
Responsibilities
The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May 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 without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Required Qualifications
Bachelor's degree
5 or more 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.
Excellent written and verbal communication skills
Ability to manage multiple priorities in a fast-paced environment
Proficiency in MS Office applications
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Master's Degree
Experience with ACO/Risk Contracting
Experience with Value Based Contracting especially in CA delegated environment
Additional Information
Scheduled Weekly Hours
40
