Become a part of our caring community and help us put health first
 

The Provider Contract Operations Specialist/ Provider Contracting Professional 2 initiates, negotiates, and executes physician, and/or other provider contracts and agreements for an organization that provides health insurance. You will report to the Director Provider, Contracting.

Provider Contract Operations Specialist / Provider Contracting Professional 2 you will

• Analyze financial impact of contracts and terms.

• Maintain contracts and documentation within a tracking system.

• May assist with identifying and recruiting providers based on network composition and needs.

• Communicate contract terms, payment structures, reimbursement rates to providers internal and external members

• Negotiate and maintain contracts with MSO or primary care providers to ensure our network meets regulatory and business requirements.

• Manage relationships with key providers to support member access, minimize disruption, and maintain competitive advantage.

• Ensure contract terms are implemented and that our organization is protected from risk, both financially and legally.

• Support cross-functional teams with updates on contracting status, rate changes, and network developments.

Use your skills to make an impact
 

Required Qualifications

• 2 or more years of experience in negotiating or servicing HMO managed care contracts

• Proficiency in Understanding of contract terms, payment structures and reimbursement rates

• Experience with public speaking or presentation skills and with provider facing communication

• Experience with Value-based Contracting

• Proficiency in MS Office Word and Excel (IE pivot tables, formulas, v-look up)

• Live in Broward, Dade, Palm Beach County

Preferred Qualifications

• Bachelor's degree

• Experience with ACO / Risk Contracting

• Bilingual (English/Spanish)

Additional Information

This role is Hybrid: Work at home with Weekly Travel at least 40% to Provider facing meetings based on business needs

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home

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. Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

#LI-BB1

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.

 

$65,000 - $88,600 per year

 

This 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-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.