Senior Provider Contracting Professional

The Senior Provider Contracting Professional in the Central Region initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements.

Key Responsibilities

• Lead provider contracting activity for assigned markets, providers, and provider types within assigned territory.
• Negotiate and execute provider agreements, amendments, renewals, and terminations in alignment with enterprise network strategy.
• Develop and maintain productive relationships with physician, provider groups, ancillary providers, and hospitals.
• Resolve complex provider issues related to contract interpretation, escalations, and relationship management.
• Partner with internal stakeholders to ensure provider contracts support affordability, quality, network adequacy, growth, and member access objectives.
• Evaluate financial and operational impacts of proposed contract terms and reimbursement models.
• Support implementation of shared savings value-based arrangements and quality rewards programs, where applicable.
• Ensure contract terms comply with Humana policies, state and federal regulations, and internal governance requirements.
• Collaborate with matrixed teams including legal, finance, network operations, credentialing, provider engagement, and clinical leadership.

Required Qualifications

• Bachelor's degree.
• 5+ 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.
• Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures, and reimbursement rates to providers.
• Proficiency in MS Office applications.

Preferred Qualifications

• Master's Degree.
• Experience with ACO/Risk Contracting.
• Experience with Value-Based Contracting.

Additional Information

• 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.
• 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

• $78,400 - $107,800 per year

Description of Benefits

• Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance, and many other opportunities.