Humana Provider Contract Specialist in New York, New York

Role: Contract Specialist Assignment: National Contracting Location:New York, NY or Work at Home Anywhere U.S.

We’re looking for associates who are dedicated to service and believe in following the Golden Rule of treating others the way you want to be treated. Humana was founded on this premise, and this value is reflected in our expectations for providing perfect service to our providers, consumers, employers, agents and others we work with. At Humana, Perfect Service® means getting the basics done right, delivering value and quality, and providing everyone with personalized attention and guidance. We want to engage with our members through every step of their journey to lifelong well-being. This includes meaningful direct consumer interaction and developing positive relationships with healthcare providers. Humana associates provide Perfect Service every day to our providers, members, employers, and colleagues. We’re looking for people who improve their own well-being by looking out for the best interests of others.

Assignment Capsule The Contract Specialist will coordinate the end-to-end setup of provider contracts. Ensure data integrity and maintenance of the contracts.

  • Ensures contracts are operationalized from contracting through implementation, leveraging standardized tools and quality processes end to end.
  • Defined point of contact for Contracting and Service (DCAV, PPG, Credentialing, Service Fund) regarding contract administration, data integrity and maintenance (including annual escalators) attributions and contract clarifications.
  • Support Humana’s providers and communicate with Humana’s clients in order to facilitate greater physician understanding and cooperation during the contracting process.
  • Prepare, assemble and mail contracts on behalf of Humana, tracking the contract’s activity and regularly reporting its status.
  • Maintains contracts, including making changes and updates using various systems i.e. network add and deletes. Changes can include:

    o Translate provider needs to change information into system request (i.e. demographic changes) o Request for TIN Changes - change TIN for individual providers and/or entire group, join a group or move groups o Request for Specialty Changes o Request for Adding Physician to Existing Practice, or request for Terminations from providers research and cleaning up dated information o IPA Updates (adds/terms/changes to groups) o Add a Physician Extender

  • Ensures initial credentialing, managing unresponsive providers through re credentialing, proofing directories and resolves discrepancies.
  • Test contract performance before operationalizing and perform audits to optimal standards for prevention, as needed.
  • Triage CCP2 tickets/issues to appropriate owners/parties (e.g. Provider Service) for resolution as needed.
  • Complete, update monitor HSD Tables to ensure network adequacy for governmental programs.
  • Audit individual provider rosters and contract loads.
  • In some markets, complete set up for delegation of credentialing and any provider network data needed for other forms of delegation.

    Key Competencies

  • Executes for Results, Accountability, Builds Trust, Interpersonal Effectiveness

    Role Essentials

  • High School Degree or equivalent

  • Prior experience in an administrative or customer support role
  • Proficiency in MS Office applications
  • Possess a strong attention to detail
  • Ability to work in a deadline driven environment
  • Capacity to maintain confidentiality
  • Strong verbal and written communication skills
  • Valid driver’s license and/or dependable transportation necessary

    Role Desirables

  • Bachelor’s Degree
  • Prior experience working in the insurance industry
  • Previous experience in claims
  • Prior contract interpretation experience
  • Previous experience with account or project coordination
  • Experience with Humana network contract systems (e.g. Service Fund, CAS, Apex, MTV) Reporting Relationships

    This position reports to a Contracting Director.

    Additional Information Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

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Title: Provider Contract Specialist

Location: New York-New York

Requisition ID: 178717