Humana

About Humana

 

Job Category:

Market Strategy - Operations

Country:

United States

Postal Code:

90501

Approximate Salary:

Not Specified

Position Type:

Full Time

Supervisor, Network Operations

Humana - Torrance, California

Posted: 11/14/2018

Description

The Supervisor, Network Operations maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Supervisor, Network Operations works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.

Responsibilities

The Supervisor, Network Operations 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. Decisions are typically are related to schedule, plans and daily operations. Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies.

               

Required Qualifications

  • Bachelor's Degree 
  • 4-6 years of progressive contracting and/or network relations/operations experience for a national health plan
  • Previous leadership experience including teambuilding
  • Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
  • Process improvement experience, experience in streamlining processes
  • Experience with Risk Contracting

Preferred Qualifications

  • Master's Degree in Business Administration or Finance
  • Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena

Scheduled Weekly Hours

40

Apply Now