Role: Provider Contracting Consultant
Assignment: Humana Gopvernment Business
Location:WAH anywhere - (Tidewater or Texoma locations preferred)
Humana Government Business, Inc. (Humana Government) is a wholly owned subsidiary of Fortune 100 health and wellness company Humana Inc. Headquartered in Louisville, KY, we have been a Department of Defense TRICARE Managed Care Support Contractor since 1995, currently serving more than 3 million beneficiaries in the South Region of the United States. Humana Government Business has the proven experience and capability to manage highly complex, large-scale health care programs throughout the federal government. Humana Government Business is comprised of several lines of business including Humana Military, Clinical Resources, and Patient Appointing Services.
Establish and maintain an appropriate and viable network of providers throughout their assigned prime service areas (PSAs) for TRICARE. Target providers for inclusion in the network based on network development strategy and complete contracts including the negotiation of discount rates. Develop and implement a renegotiation strategy to insure HUMANA GOVERNMENT BUSINESS meets or exceeds the discount guarantee. Develop and maintain a cost effective provider network of hospital, physicians and allied health providers in the required PSAs. Requirements include achieving budgeted discount percentages and network size to satisfy our network goals for new and existing providers. Develop anchor hospital and preferred provider strategy and guidelines to foster optimum steerage of beneficiaries to appropriate network providers and facilities in collaboration with network managers and appropriate market leadership. Maintain a network of 20,000 providers in ‘’ NO REQUIRED PSAs’’ and 65,000 in required PSAs in keeping with the HUMANA GOVERNMENT BUSINESS T-3 proposal requirements Participate in market network collaboration meetings in order to foster greater understanding of the TRICARE program and improve cost awareness. Insure that newly contracted providers submit accurate initial credentialing and contract packages.
Our Department of Defense contract requires U.S. Citizenship for this role
Bachelors Degree and 3 years or more of provider relations experience, and if non degreed, 5 years or more of provider relations experience.
3 years or more of working in a medical environment dealing with managed care or insurance issues (such as claims, benefits, etc.)
Previous experience in provider contracting or negotiations
Strong PC skills with Microsoft Office - Word, Excel and Powerpoint
Strong written communication and presentation skills
Reporting Relationships This position reports to a Network Development Manager.
Title: Provider Contracting Consultant
Other Locations: US-KY-Louisville, US-Texas-Irving, US-Oklahoma-Oklahoma City
Requisition ID: 178649