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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Provider Contracting, Network Management, and Provider Relations within the healthcare sector, with a strong focus on financial performance, quality metrics, and strategic planning. Proficient in analyzing healthcare costs and quality performance, with advanced skills in MS Excel for data analysis.
Highest-signal resume keywords
Provider Contracting ExperienceProject Management ExperienceKnowledge of HEDIS and STARs MeasuresFinancial Trend AnalysisMedicare Policies Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider RelationsFinancial Performance AnalysisQuality Performance ImprovementProject ManagementData AnalysisReimbursement MethodologiesStrategic PlanningHealthcare Cost AnalysisMS Excel ProficiencyDocumentation and Coding
Soft Skills
Relationship BuildingIndependent JudgmentDecision-MakingPresentation SkillsCollaboration with Leadership
Industry Keywords
Managed CareHealthcare SystemsPopulation HealthOperational ExcellenceMember ExperienceProvider PerformanceMarket GrowthQuality ManagementHealth Plan RelationshipsPHI/HIPAA Compliance
About the role
Key responsibilities & impact- Develop and grow positive, long-term relationships with physicians, providers and healthcare systems
- Support and improve financial and quality performance within contracted health plan relationships
- Represent the health plan/provider relationship across financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements, provider performance, member experience, market growth, provider experience and operational excellence
- Advise executives and develop functional strategies, often segment-specific, on matters of significance
- Exercise independent judgment and decision-making on complex issues
- Analyze variable factors and determine the best course of action
- Travel occasionally to Humana offices for training or meetings
Requirements
What you’ll need- 5 or more years of health care or managed care experience with Provider Contracting, Network Management or Provider Relations
- 2 or more years of demonstrated project management experience
- Experience partnering with leadership on strategic initiatives
- Proven planning, preparation and presenting skills
- Established knowledge of reimbursement and bonus methodologies
- 2+ years of experience working with Stars/HEDIS measures
- Must live in the State of Louisiana
- Ability to travel as needed (up to 25%)
- Bachelor's Degree preferred
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
- Comprehensive knowledge of Medicare policies, processes and procedures
- Advanced working knowledge of MS Excel, including vLookups and pivot tables
- Minimum download speed of 25 Mbps and upload speed of 10 Mbps
- Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual 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
- Personal wellness support
- Healthcare decision support