Senior Hospital Contracting Strategist
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The Senior Hospital Contracting Strategist / Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting.
As the Senior Hospital Contracting Strategist/ Senior Provider Contracting Professional you will
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Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
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Extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership
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Experience with Medicare Advantage, Medicaid, and value based-contracting
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Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements
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Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable
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Communicate contract terms, payment structures, and reimbursement rates to providers
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Analyze financial impact of contracts and terms
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Maintain contracts and documentation within a tracking system
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Help with identifying and recruiting providers based on network composition and needs
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
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5 or more years of Hospital negotiation experience in Medicare
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Leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
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5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
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Experienced in negotiating managed care contracts with Hospital systems inclusive of post acute, ancillary providers and physicians.
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Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.
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Understand and interpret Hospital contract language
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Proficient in Microsoft Office: Word, Excel and PowerPoint
Preferred Qualifications
- Master's Degree
- Experience with ACO/Risk Contracting
- Experience with Value Based Contracting
Additional Information
8am to 5pm EST, Travel based on business needs
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana 's offices for training or meetings may be required. Scheduled Weekly Hours
40 Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$78,400 - $107,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits
Humana , Inc. and its affiliated subsidiaries (collectively, “ Humana ”) offers competitive benefits that support whole-pe