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Humana Inc.

Provider Contracting Contract Administrator

Humana Inc. - Salt Lake City, UT



Job Description
Role: Contract AdministratorAssignment: National ContractingLocation:  Sandy, UT 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.  Assignment Capsule 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.  Key Competencies   Executes for Results, Sees the Whole System, Relationship and Account Management, Collaborates

Job Requirements
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 Role DesirablesAssociate’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)Reporting Relationships This position reports to a Contracting Director.  Additional InformationHumana 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. Internal Only: Additional InformationIf 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.  

10 days 4 hours ago

Humana Inc.

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Provider Contracting Contract Administrator Humana Inc. - Salt Lake City, UT, United States

   

Location: Salt Lake City, UT

Company Profile:
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.