Senior Hospital Contracting Strategist

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Initiate, negotiate, and finalize contracts and agreements with physicians, hospitals, and other providers.

• Lead negotiations pertaining to hospital and health system agreements, covering reimbursement, contract terms, amendments, renewals, and value-based agreements.

• Assess reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment models.

• Collaborate with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure that contracts are financially viable and operationally feasible.

• Convey contract terms, payment structures, and reimbursement rates to providers effectively.

• Evaluate the financial implications of contracts and their terms.

• Maintain contracts and related documentation within a tracking system.

• Assist in identifying and recruiting providers based on network composition and requirements.

• Report to the Director of Provider Contracting.

• Work from 8am to 5pm EST, with travel as required by business needs.

⛳️ Requirements

• Bachelor's degree.

• At least 5 years of experience in hospital negotiations related to Medicare.

• Minimum of 5 years of progressive network management experience, which includes hospital contracting and network administration within a healthcare organization.

• Experience in negotiating managed care contracts with hospital systems, post-acute providers, ancillary providers, and physicians.

• Capability to analyze, comprehend, and convey the financial implications of contract terms, payment structures, and reimbursement rates to providers.

• Proficiency in understanding and interpreting hospital contract language.

• Strong command of Microsoft Office applications: Word, Excel, and PowerPoint.

• Master's degree is preferred.

• Experience with ACO/Risk Contracting is preferred.

• Experience with Value-Based Contracting is preferred.

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps.

• Ability to work from a designated area without interruptions to protect member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Occasional travel to Humana offices for training or meetings.