The Manager, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Manager, Provider Contracting works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
Location: Travel 50% Northwest counties in FL: Homes, Bay, Leon, Madison, Taylor, etc – Work at Home
The Manager, Provider Contracting 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. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Lead Provider Contracting within a market
Initiate and maintain productive long-term relationships with provider representatives, subscribers, hospitals, account managers and internal sales teams
Provide effective operations management, ensuring that all contracts are within required guidelines and financial parameters
Apply economic and strategic planning models to all endeavors in your region in order to align business, process, and operational principles with area-specific goals
Ensure compliance of Medicaid requirements as it relates to Provider Network and Provider Relations operations
Strong focus on building and maintaining provider relationships, as well as ensuring all participating network providers are adequately trained on Humana’s policies and procedures, including but not limited to Medicaid requirements
Bachelor’s Degree in Business, Finance or a related field; or a minimum of 10 years’ provider contracting experience to include hospital contracting
A minimum of 5 years’ progressive contracting experience for a national health plan
Solid leadership/management experience including supervisory and teambuilding
Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
Master’s Degree in Business Administration or Finance
Experience with ACO/Risk Contracting
Value based contracting experience
Reporting RelationshipsThis position reports to a Contracting Director.Schedule: M-F 8 am to 5 pm
Scheduled Weekly Hours
Equal Opportunity Employer
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