Provider Services Advisor - Humana
Richmond, VA
About the Job
Become a part of our caring community and help us put health first
The Provider Services Advisor will be responsible for the strategic and tactical support of the Provider Services team. They will advise the Provider Services Director 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, develop and execute upon a provider communication, and provider materials development strategy. Initially, the Provider Services 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 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.
Position 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 provider performance improvement.
+ 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 Virginia.
+ 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
Use your skills to make an impact
Required Qualifications:
+ Bachelor's Degree.
+ 6+ years of related experience, including provider relations or engagement, provider communications and education, and/or related health plan operations
+ 2+ years of project management experience
+ Experience supporting Government Programs (ie: Medicare/Medicaid, etc)
+ Strategic thinker with the ability to identify, prioritize, and solve complex business problems
+ Strong attention to detail
+ Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team and internal business partners
+ The applicant must be located in or willing to relocate to Virginia - position may be based at our office in Richmond or remote within the state
Preferred Qualifications:
+ Master's Degree.
+ Understanding of managed care contracts, including contract language and reimbursement
+ Familiar 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
+ This position will be Hybrid/Home along with working in the field
+ 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 Criteria
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ 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 employees 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.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$93,000 - $128,000 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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.
The Provider Services Advisor will be responsible for the strategic and tactical support of the Provider Services team. They will advise the Provider Services Director 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, develop and execute upon a provider communication, and provider materials development strategy. Initially, the Provider Services 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 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.
Position 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 provider performance improvement.
+ 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 Virginia.
+ 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
Use your skills to make an impact
Required Qualifications:
+ Bachelor's Degree.
+ 6+ years of related experience, including provider relations or engagement, provider communications and education, and/or related health plan operations
+ 2+ years of project management experience
+ Experience supporting Government Programs (ie: Medicare/Medicaid, etc)
+ Strategic thinker with the ability to identify, prioritize, and solve complex business problems
+ Strong attention to detail
+ Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team and internal business partners
+ The applicant must be located in or willing to relocate to Virginia - position may be based at our office in Richmond or remote within the state
Preferred Qualifications:
+ Master's Degree.
+ Understanding of managed care contracts, including contract language and reimbursement
+ Familiar 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
+ This position will be Hybrid/Home along with working in the field
+ 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 Criteria
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ 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 employees 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.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$93,000 - $128,000 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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.
Source : Humana