Network Operations Lead - Behavioral Health/Medicaid

Profile

Job Information
Humana
Network Operations Lead - Behavioral Health/Medicaid
in
Charlotte
North Carolina
Description
The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Network Operations Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
Responsibilities
The Network Operations Lead manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Required Qualifications
Bachelor's degree
3 or more years of provider contracting or physician network development experience
1 years of experience working with Medicaid contracts
Understanding of Medicaid compliance
Experience with analyzing, understanding and communicating financial trends
2 or more years of project leadership experience
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
We will require full COVID vaccination (**** for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.
If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
Preferred Qualifications
Experience working with behavioral health contracts
Experience with credentialing and contract management systems
Working knowledge in the areas of Group Practice Management, Long-Term Acute Care, home health, home infusion, behavioral health, ambulatory surgery, and the outpatient experience
Additional Information
This position will be remote/work at home and can be based anywhere, nationwide.
Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
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. 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.
Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40

Company info

Sign Up Now - HealthcareCrossing.com