Provider Services Advisor (Medicaid)
Company: Humana
Location: East Chicago
Posted on: May 28, 2023
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Job Description:
**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**
40Humana 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.
Keywords: Humana, Chicago , Provider Services Advisor (Medicaid), Other , East Chicago, Illinois
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