Humana Provider Contracting Professional 2 - Behavioral Health in Boston, Massachusetts
The Provider Contracting Professional 2 role initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. The Provider Contracting Professional 2 will support our Behavioral Health Network and work assignments will be varied and frequently require interpretation and independent determination of the appropriate courses of action. Will have a region of states they are responsible for, and ensure access to care.
The Behavioral Health Provider Contracting Professional 2 will support and communicate contract terms, payment structures, and reimbursement rates to providers, with a Medicaid focus specific to Behavioral Health/Substance Use Disorder. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. Will assist with identifying and recruiting providers based on network composition and needs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
2-5 years of experience in negotiating Behavioral Health/Substance Use Disorder managed care contracts with physicians, hospitals and/or other ancillary specialty providers
Demonstrated experience and success in executing multiple agreements on an ongoing basis
Recruitment of key behavioral health providers and agencies with a statewide focus, with an understanding of services provided and various levels of care will be key
Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
Excellent written and verbal communication skills and understanding of behavioral health and substance use disorder care
Ability to manage multiple priorities in a fast-paced environment
Proficiency in MS Office applications
Travel to provider offices up to 25% of the time may be required as we return to in-person meetings
We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.
If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
Experience working with Medicaid contracts
Experience with ACO/Risk Contracting in behavioral health
Experience with Value Based Contracting in behavioral health
This position will be "remote/work at home" and can be based anywhere, nationwide.
Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
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