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in Meeham, MS

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Hours Part-time, Full-time
Location Meeham, Mississippi

About this job

Role: Provider Contracting Consultant
Assignment: National Contracting
Location: Various WAH locations, anywhere

Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their families. For more than 20 years, Humana Military has strived to create better health outcomes and simplified experiences for millions of beneficiaries across the United States through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, and progressive approaches to care drive Humana Military to be a thought leader in the industry and an essential partner to the Government.

Assignment Capsule
Establish and maintain an appropriate and viable network of providers throughout their assigned prime service areas (PSAs) for TRICARE. Target providers for inclusion in the network based on network development strategy and complete contracts including the negotiation of discount rates. Develop and implement a renegotiation strategy to insure HUMANA GOVERNMENT BUSINESS meets or exceeds the discount guarantee.
Develop and maintain a cost effective provider network of hospital, physicians and allied health providers in the required PSAs. Requirements include achieving budgeted discount percentages and network size to satisfy our network goals for new and existing providers.
Develop anchor hospital and preferred provider strategy and guidelines to foster optimum steerage of beneficiaries to appropriate network providers and facilities in collaboration with network managers and appropriate market leadership.
Maintain a network of 20,000 providers in ‘’ NO REQUIRED PSAs’’ and 65,000 in required PSAs in keeping with the HUMANA GOVERNMENT BUSINESS T-3 proposal requirements
Participate in market network collaboration meetings in order to foster greater understanding of the TRICARE program and improve cost awareness.
Insure that newly contracted providers submit accurate initial credentialing and contract packages. Role Essentials

Our Department of Defense contract requires U.S. Citizenship for this role
Bachelors Degree and 3 years or more of provider relations experience, and if non degreed, 5 years or more of provider relations experience.
3 years or more of working in a medical environment dealing with managed care or insurance issues (such as claims, benefits, etc.)
Previous experience in provider contracting and negotiations
Strong PC skills with Microsoft Office - Word, Excel and Powerpoint
Strong written communication and presentation skills
Role Desirables

Knowledge of the TRICARE program and other government contracting experience as well as the contracting methodology used.

Reporting Relationships
This position reports to a Director of Contracting.