Role: Provider Contractor Rep - Large Practice and Ancillary Assignment: National Contracting Location: West Palm Beach, FL
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 Be part of the Provider Contracting world at Humana where you will help build and maintain a competitive network for our members. As a Large Practice and Ancillary Contracting Executive you will support the provider network by utilizing advanced data and analytical methodologies and tools. Use the data to develop and execute programs for process and productivity improvements. Provide servicing and contracting support to participating PCP, MSO, Ancillary and Specialty Providers/Groups. Support and drive strategic initiatives aligned with the organizations and departmental objectives and business strategies. * Initiate and maintain productive long-term provider-client relationships with external and internal customers.
Provide effective operation, analytical and negotiation skills to ensure that all contracts are within required guidelines and financial parameters.
Work with leaders and departments to assure economic and strategic planning models to all endeavors in order to align business, process and operational principles with area-specific goals including expansion markets as assigned.
Negotiate and re-negotiate Contracts.
Function as the point-of-contact for all on-going contractual and service issues as needed by Contracted Providers.
Facilitate Contracted Provider education, training in order to increase their familiarity and satisfaction with CarePlus Health Plans’ systems and strategies.
Create analyses and summaries for identified network gaps and deficiencies.
Interface with market leaders to align contracting and business needs efforts.
Set targets and priorities in order to meet national and market-specific network needs.
Manage multiple projects and priorities
Act as a project/initiative lead as assigned by leadership
Provider relations support
High school diploma or equivalent
Experience in negotiating Medicare and Centers for Medicare/Medicaid (CMS) reimbursement methodologies with large physician groups.
Provider Contracting skills, including contract preparation and implementation, financial analysis and rate proposal development
Proficiency in analyzing, understanding and communicating financial trends
Intermediate knowledge of MS Word and Excel
Overall knowledge of Medicare standards and regulations
Interpersonal and communications skills
Customer Service skills
Strong organizational skills
Valid State of Florida Driver’s license
Successful track record in managing multiple projects and priorities
Ability to travel locally up to 50% of the time in Palm Beach County area
Bachelor’s Degree (BA/BS)
Working knowledge in the areas of Group Practice Management, Long-Term Acute Care, home health, home infusion, behavioral health, ambulatory surgery, and the outpatient experience Reporting Relationships This position reports to a Director of Network Operations.
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.
Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Please be advised, the role opportunity displayed here is for CarePlus - a wholly owned subsidiary of Humana Inc.
Title: Provider Contractor Rep - Large Practice and Ancillary - West Palm Beach
Location: FL-West Palm Beach
Requisition ID: 178246