Job description

Description Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives.

We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, Description Healthcare isn’t just about health anymore.

It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives.

We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry. The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance.

The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system.

May assist with identifying and recruiting providers based on network composition and needs. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

The role supports the San Antonio market. This is a REMOTE position. Essential Functions Responsible for building relationships with specialty providers in the area. Responsible for scheduling meet and greets and hosting Joint Operating Committee meetings with specialty partners.

Responsible for identifying cost savings opportunities for medical centers. Responsible for training medical centers/staff Health plan processes. Responsible for managing several projects at any given time. Responsible for meeting frequently with market president and regionals on ongoing issues.

Required Qualifications Must live within the San Antonio/Corpus Christi/or El Paso area. Must be fluent in English. 5 years' experience in Healthcare or experience in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems. Ability to analyze and solve problems using learned techniques and tools.

Excellent listening and communication skills both verbally and in a professional written manner. Proficiency in MS Office applications. Experience with Medicare Advantage processes. Experience with Health Plan processes.

Must be able to travel in the Market 25%-50% (this will vary by month to month based on the needs of the market) Preferred Qualifications Bachelor's degree 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company. Experience with ACO/Risk Contracting Experience with Value Based Contracting Being a part of the Conviva team gives you: We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k, tuition reimbursement, vacation, paid holidays, work-life balance, growth, a positive and fun culture and much more. Alert: Conviva, a subsidiary of Humana, values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.

When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website. Interview Format: MODERN HIRE As part of our hiring process, we will be using an exciting interviewing technology provided by 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 or computer 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. Vaccine Policy Associates are required to be fully COVID vaccinated, including booster, or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. If progressed to offer, candidates will be required to: Provide proof of full vaccination, including booster OR Provide proof of applicable exemption including any required supporting documentation.

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