Location
Apopka, FL, United States
Posted on
Jul 14, 2021
Profile
Description
The Provider Contracting Professional 2 communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Understands alternate payment structures and quality incentives for Long-Term Care (LTC) providers. Maintains contracts and documentation within a tracking system. May 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.
Responsibilities
The Provider Contracting Professional 2 initiates, negotiates, and executes Long-Term Care (LTC) provider contracts and agreements for an organization that provides LTC health insurance.
Works assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsible for network relationship management, including, but not limited to: quality, payment, provider experience, financial performance, industry trends, legislative changes, AHCA contract requirements.
Implements and executes network initiatives and strategic goals for network adequacy, contracting payment initiatives and AHCA compliance.
Identify and support new trends and savings opportunities related to network.
Oversight of provider education/training, ensure trainings support provider needs and required by new AHCA contract.
Build and support provider association relationships.
Work with clinical leaders to address concerns and ensure enrollees have appropriate access to providers.
Required Qualifications
Must live in and must be able to travel within the following Florida counties: Brevard, Osceola, Seminole and Orange (Region 7).
Bachelor's Degree, or equivalent work experience in Long-Term Care Manage Care (LTCMC) health plan.
2 years of experience in negotiating managed care contracts with physician, hospital and/or other ancillary provider contracts and/or 2 years of experience working in LTCMC.
Intermediate to advance proficiency in Adobe PDF and MS Office products specifically Excel.
Prior experience building and maintaining relationships with provider groups.
Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
Excellent written and verbal communication skills.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
ACHA Level II background check required.
Preferred Qualifications
Strong, established relationships within the LTSS provider community.
Bilingual a plus.
Additional Information
Schedule: Monday through Friday 8:30 am -5:00 pm.
Training: Training Approx. 2 weeks.
Travel: Same day travel within areas of Florida, 25% or more based on business needs. Note: Travel is suspended at this time due to business travel restrictions. Travel restrictions are scheduled to be lifted October 2021.
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Montage/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 and/or an SMS Text Messaging 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.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40
Company info
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