Provider Services Advisor Medicaid

Profile

Description

Humana Healthy Horizons in Indiana is seeking a Provider Services Advisor (Market Development Advisor) who will be responsible for the strategic and tactical support of the Provider Services team. They will advise the Director, Provider Services on the day-to-day and strategic operations of the team, process development and improvement to drive standardization and efficiencies across the team. They will complete related state reports, develops and executes upon a provider communication and provider materials development strategy. Initially, the Provider Services Advisor (Market Development Advisor) will play a key role in supporting new market implementation activities. They will partner cross-functionally within the market and across the enterprise on matters of significance. This Provider Services Advisor (Market Development Advisor) exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. They use independent judgment requiring analysis of variable factors and determining the best course of action.

Responsibilities

Advises Provider Services Director on strategic and day to day operations of the overall Provider Services team, which includes provider relations, claims education, provider engagement, and practice transformation functions.

Establishes infrastructure to measure KPIs and other metrics to ensure compliance with related managed care contractual requirements.

Develops initial and manage annual updates of the market's Provider Support Plan, in partnership with the Director, as well as any other related required state reporting.

Oversees provider communications (fax blasts, emails, bulletins, website, or provider portal content updates) end to end process, including development of content and management through the approval process.

Manages provider training and education strategy, including advising on and/or creating market-based provider materials and contributing to provider manual and required training materials.

Prior to market go-live, contributes to implementation of contractual requirements and day-to-day business processes/functions.

Leads process development or improvement and communicates them to team members to drive efficiencies, standardization, and best practices for Indiana.

Drives development of ad hoc strategic initiatives to execute on the Medicaid Long-Term Services and Support (LTSS)/Home and Community Based Services (HCBS) provider journey, provider relationship management model, and other strategic initiatives.

Facilitates workgroup calls/meetings/discussions to ensure successful execution of Provider Support Plan.

Partners with corporate Medicaid Provider Services team to rollout new segment-wide process or technology enhancements in support of the overall Provider Services team.

Required Qualifications

Must reside in the state of Indiana.

Must be able to travel in the state of Indiana.

Bachelor's degree.

Five (5) years of related experience, including provider relations or engagement, provider communications and education, and/or related health plan operations.

Two (2) or more years of project management experience.

Proven experience writing and delivering presentations to members of leadership teams and internal business partners

Strategic thinker with the ability to identify, prioritize, and solve complex business problems.

This role is a 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.

Work at Home Requirements

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

Master's degree.

Experience working in Medicaid.

Familiarly with LTSS/HCBS providers and/or DSNP/Medicaid-Medicare integration.

Strong understanding of health plan operations.

Experience operating in a matrixed environment.

Project management certification.

Additional Information:

Workstyle: Remote, but may vary due to travel and occasional onsite work at the Humana Healthy Horizons office in Indiana.

Travel: Up to 15% travel in the state of Indiana to provider offices and Humana locations.

Core Workdays & Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time(EST).

Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

Direct Reports: 1

Interview Format

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.

Social Security Task

Alert: 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.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com