Senior Provider Contracting Professional - Behavioral Health/Medicaid

📋 Description

• • Negotiate hospital, physician group, and ancillary provider contracts at market-competitive pricing within the behavioral health and Medicaid space.
• • Initiate and maintain long-term, productive relationships with key hospital and group practice administrators and decision-makers.
• • Serve as the subject matter expert on assigned regional behavioral health networks, ensuring alignment with Humana’s consumer-focused business strategy.
• • Manage large provider accounts and complex provider relations, including re-prioritization of corporate and consumer needs based on network composition.
• • Communicate contract terms, payment structures, and reimbursement rates clearly and proactively to providers to ensure transparency and compliance.
• • Analyze the financial impact of contract terms, payment models, and reimbursement rates to inform negotiation strategy and business outcomes.
• • Maintain accurate and up-to-date contract documentation within the organization’s tracking system.
• • Collaborate cross-functionally with other departments to ensure efficient and effective business results and operational alignment.
• • Participate in C-suite level interactions, both internally and externally, to represent provider contracting interests and strategic priorities.
• • Assist in identifying and recruiting new providers to strengthen network adequacy and meet Medicaid behavioral health service demands.
• • Ensure all contracting activities comply with regulatory requirements and protect member PHI in accordance with HIPAA standards.
• • Occasional travel to Humana offices may be required for training, meetings, or strategic planning sessions.
• • Work from a dedicated, interruption-free home space to safeguard confidential health information.
• • Utilize internet service with minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable, or DSL connections preferred.
• • Receive company-provided telephone equipment appropriate for business requirements.
• • For associates residing in California, Illinois, Montana, or South Dakota, receive a bi-weekly internet expense reimbursement.