Humana

About Humana

 

Job Category:

Market Strategy - Engagement

Country:

United States

Postal Code:

55305

Approximate Salary:

Not Specified

Position Type:

Full Time

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Provider Engagement Executive

Humana - Minnetonka, Minnesota

Posted: 12/10/2018

Description

The Provider Engagement Executive develops and grows positive, long-term relationships with physicians, providers, and healthcare systems in the Twin Cities and Minnesota, in general, to support and improve our operational service model while optimizing financial and quality performance. The role works and resolves problems of diverse scope and complexity ranging from moderate to substantial. The Provider Engagement Executive aims to deliver a positive provider service experience by applying process improvement, project management, and data analysis in order to drive solutions to key operational issues – as well as optimizing performance and brand reputation by driving key initiatives involving risk adjustment, clinical utilization, and quality.

Responsibilities

The Provider Engagement Executive leads assigned provider relationships in Minnesota, particularly the Twin Cities, in the key areas of service operations, financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance.  To deliver an optimal service experience, the role will work closely with internal operational stakeholders to monitor and track provider metrics related to overpayment audits, provider call center intake, claims processing, clinical operations, credentialing, physician roster accuracy, and member attribution. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques.

Apply knowledge to perform analysis through data to identify, track, and resolve issues that impact timely and accurate claims processing, payment, and overall operations across several functional areas.  Utilize knowledge to directly support claims processing teams through documented work instructions and inventory management.

Interact with internal departments as well as external sub-contractors to document, prioritize, define, and drive needed changes.  Maintain oversight of changes to system logic or operational procedures. Maintain project status updates and create reports to monitor results.  Provide status updates to management. Perform data analysis, interpret information, identify challenges, and formulate solutions.  Advises and handles escalated issues.

Creating high quality analysis and sections of deliverables that clearly frame objectives, issues, and challenges, and articulate insightful findings and recommendations

Works collaboratively with fellow team members and leaders across the company

The Provider Engagement Executive leads assigned provider relationships in Minnesota, particularly the Twin Cities, in the key areas of service operations, financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance.  To deliver an optimal service experience, the role will work closely with internal operational stakeholders to monitor and track provider metrics related to overpayment audits, provider call center intake, claims processing, clinical operations, credentialing, physician roster accuracy, and member attribution. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques.

Apply knowledge to perform analysis through data to identify, track, and resolve issues that impact timely and accurate claims processing, payment, and overall operations across several functional areas.  Utilize knowledge to directly support claims processing teams through documented work instructions and inventory management.

Interact with internal departments as well as external sub-contractors to document, prioritize, define, and drive needed changes.  Maintain oversight of changes to system logic or operational procedures. Maintain project status updates and create reports to monitor results.  Provide status updates to management. Perform data analysis, interpret information, identify challenges, and formulate solutions.  Advises and handles escalated issues.

Creating high quality analysis and sections of deliverables that clearly frame objectives, issues, and challenges, and articulate insightful findings and recommendations

Works collaboratively with fellow team members and leaders across the company

               

Required Qualifications

  • Bachelor's Degree
  • 5+ years of health care or managed care with Network Management and Provider Operations and/or Provider Relations experience
  • 2+ years of demonstrated project management experience and partnering with senior leadership on strategic initiatives 
  • Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies 
  • Demonstrated ability to manage multiple projects and meet deadlines
  • Comprehensive knowledge of all Microsoft Office applications 
  • Project management and process improvement and mapping experience

Preferred Qualifications

  • Master's Degree
  • Knowledge of claims data and integrity management
  • Knowledge of Medicare Advantage

Scheduled Weekly Hours

40

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