Director Network Operations

Profile

Description

The Director, 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 Director, Network Operations requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

The Director, 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 related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

Required Qualifications

Bachelor's Degree

8 or more years of technical experience

5 or more years of management experience

Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena

Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Experience with ACO/Risk Contracting

Master's Degree in Business Administration or Finance

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com