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Humana Provider Contracting Executive in Lancaster, South Carolina

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

  • 5 or more years of progressive network management experience including provider contracting and network administration in a healthcare company

  • Extensive contract negotiation skills, 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

  • Hospital contracting experience

  • Experience with ACO/Risk Contracting

  • Experience with Value Based Contracting

Scheduled Weekly Hours

40

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