Provider Contracting Executive - GA
Posted on: 27 Feb 2021
Roswell, GA
Job Description
Description
The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems of diverse scope and complexity ranging from moderate to substantial.
Responsibilities
The Provider Contracting Executive 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. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Required Qualifications
* Bachelor's degree
* 8 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
* Experience with ACO/Risk Contracting
* Experience with Value Based Contracting
* or more years of project leadership experience
* Extensive provider contracting skills, including contract preparation and implementation, financial analysis and rate proposal development
* Excellent written and verbal communication skills and experience presenting to varied audiences
* Ability to manage multiple priorities in a fast-paced environment
* Knowledge of Microsoft Office applications
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
* Master's Degree
Additional Information
Ideal candidates should live within GA or Upstate SC (Greenville or Spartanburg), Northern FL, Charlotte NC or TN.
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
