Provider Contract AdministratorHumana Inc. - Irving, TX
Provider Contract Administrator','185305','US-Texas-Irving','','Office','Office','Full-time','No','!*!Role: Provider Contract Administrator
Assignment: Humana Behavioral Health
Location: Dallas TX
We’re looking for associates who are dedicated to service and believe in following the Golden Rule of treating others the way you want to be treated. Humana was founded on this premise, and this value is reflected in our expectations for providing perfect service to our providers, consumers, employers, agents and others we work with. At Humana, Perfect Service® means getting the basics done right, delivering value and quality, and providing everyone with personalized attention and guidance. We want to engage with our members through every step of their journey to lifelong well-being. This includes meaningful direct consumer interaction and developing positive relationships with healthcare providers. Humana associates provide Perfect Service every day to our providers, members, employers, and colleagues. We’re looking for people who improve their own well-being by looking out for the best interests of others.
The Contract Administrator will manage the end-to-end setup of complex provider contracts. Ensure data integrity and maintenance of the contracts.
Ensures contracts are operationalized from contracting through implementation, leveraging standardized tools and quality processes end to end.
Defined point of contact for Contracting and Provider Service (DCAV, PPG, Credentialing, Service Fund) regarding contract administration, data integrity, testing/auditing, maintenance (including annual escalators) attributions and contract clarifications for more complex contracts. This may include path-to-value and value-based contracts.
Support Humana’s providers and communicate with Humana’s clients in order to facilitate greater physician understanding and cooperation during the contracting process.
Maintains contracts, including making changes and updates using various systems i.e. network add and deletes. Collaborates with Provider Engagement Executive or Consultant to complete reassignment of membership.
Ensures initial credentialing, managing unresponsive providers through re credentialing, and resolves discrepancies.
Test contract performance before operationalizing and perform audits to optimal standards for prevention. May lead/oversee testing and/or auditing of contracts by other associates.
(In some markets) Complete system set up for delegation of credentialing and any provider network data needed for other forms of delegation. Manage delegated relationship data: credentialing, UM, claims.
Manage operational issues with IDS, Specialists, and key Providers.
Work with Contract Directors to assist with and follow up on routine provider contracts.
Executes for Results, Sees the Whole System, Relationship and Account Management, Collaborates','!*!Role Essentials
High School Degree or equivalent
Proficiency in MS Office applications
Possess a strong attention to detail
Ability to work in a deadline driven environment
Strong verbal and written communication skills
Previous account management, project management or related experience
Valid driver’s license and/or dependable transportation necessary
Associate’s or Bachelor’s Degree
Prior experience working in the insurance industry
Proficiency in MS Access
Previous experience in claims
Prior contract interpretation experience strongly desired
Previous provider experience (provider contract, provider relations, or provider service)
This position reports to a Contracting Director.
Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter!. Please be sure to provide the requisition number so we may be able to research your request quicker.
','At Humana, we’re also committed to making the resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. We know your well-being is important to you, and it’s important to us too.
If you share our passion for helping people, we likely have the right place for you at Humana. After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.','Provider Contract Administrator
69 days 9 hours ago
applyProvider Contract Administrator Humana Inc. - Irving, TX, United States
Humana's diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Find out how Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.
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