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

Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements

Extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership

• Experience with Medicare Advantage, Medicaid, and value based-contracting
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements
• Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable
• Communicate contract terms, payment structures, and reimbursement rates to providers
• Analyze financial impact of contracts and terms
• Maintain contracts and documentation within a tracking system
• Help with identifying and recruiting providers based on network composition and needs
• Use your skills to make an impact
• Required Qualifications
• Bachelor's degree
• 5 or more years of Hospital negotiation experience in Medicare
• Leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• 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 Hospital systems inclusive of post acute, ancillary providers and physicians.

Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.

Understand and interpret Hospital contract language

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.