Director, Provider Contracting
Posted on: 30 Jan 2021
Federal Way, WA
Job Description
Description
The Director, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Director, Provider Contracting requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
Responsibilities
The Director, 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 the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.
Required Qualifications
* Bachelor's Degree
* 7 years extensive provider contracting experience
* 7 years proven leadership experience, including teambuilding
* Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
* Strong understanding of network operations
* Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
* Master's or J.D. Degree
* Experience with ACO/Risk Contracting
* Value based contracting experience
* Established provider relationships across the Inter-Mountain Region
Additional Information
Scheduled Weekly Hours
40
Humana
Louisville, KY
Humana Inc., together with its subsidiaries, operates as a health and well-being company in the United States. The company offers medical and supplemental benefit plans to individuals. It also has contract with Centers for Medicare and Medicaid Services to administer the Limited Income Newly Eligible Transition prescription drug plan program; and contracts with various states to provide Medicaid, dual eligible, and long-term support services benefits.
In addition, the company provides commercial fully-insured medical and specialty health insurance benefits comprising dental, vision, and other supplemental health and voluntary insurance benefits; financial protection products; and administrative services only products to individuals and employer groups, as well as military services, such as TRICARE South Region contract.
Further, it offers pharmacy solutions, provider services, predictive modeling and informatics services, and clinical care services, such as home health and other services to its health plan members, as well as to third parties. As of December 31, 2018, the company had approximately 17 million members in medical benefit plans, as well as approximately 6 million members in specialty products. Humana Inc. was founded in 1961 and is headquartered in Louisville, Kentucky.
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IndustryHealthcare
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No. of Employees41,600
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Website
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Jobs Posted1359
