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Humana Senior Provider Contracting Professional - Behavioral Health in Boston, Massachusetts

Description

The Senior Provider Contracting Professional of Behavioral Health initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Contracting Professional with a focus on behavioral healthcommunicates 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. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

  • Bachelor's degree

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

  • Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems.

  • Experience with Community Mental Health Centers, Opioid Treatment Programs, Medication Assisted Treatment providers and Substance Use Disorder services

  • Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.

  • Excellent written and verbal communication skills

  • Ability to manage multiple priorities in a fast-paced environment

  • Proficiency in MS Office applications

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

  • Travel to provider offices may be required up to 25% of the time 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.

Preferred Qualifications

  • Master's Degree

  • Experience with ACO/Risk Contracting including Behavioral Health

  • Experience with Value Based Contracting including Behavioral Health

Additional Information

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

40

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