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Responsibilities
The Provider Contracting Professional 2 is directly responsible for growing the dental network by successfully communicatinges 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 Targets specific dental identifying and recruiting providers for network participation 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. Prioritization of leads, fee schedule reimbursement, needed available for travel for local and out of state travel for in person dental office visits, research of local community events and how Humana can support these events, identification of local dental society sponsorship opportunities and assisting providers with a variety of issues. Examples include;meeting specific number of contract goals, identifying which fee schedule to offer and negotiating to determine the value of the provider to all Humana customers based on the compensation. Meet with Dental Providers face to face.
Required Qualifications
- Bachelor's degree or equivalent work experience.
- 2 - 5 years of experience in negotiating managed care contracts with dentist, DSO, and dental practice managers.
- Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
- Excellent written and verbal communication skills
- Ability to manage multiple priorities in a fast-paced environment
- Proficiency in MS Office applications
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Travel is required for this role to visit Dental Provider offices - 3 days per week or as necessary. Travel could be regionally, and some air travel might be necessary. Overnight travel may be necessary.
- 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.
- Prefer someone who currently resides in the state of IN, IL or OH
Preferred Qualifications
- Master's Degree
- Experience with ACO/Risk Contracting
- Experience with Value Based Contracting
Additional Information
WAH requirements: 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.
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Scheduled Weekly Hours
40Not Specified
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