Senior Process Improvement Professional HealthCare Provider Value exp. Work at Home

Profile

Description

The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Process Improvement Professional supports provider experience arising under the Medicaid Operating Model, including work across the value chain (i.e. claims, contracting and provider servicing). They will manage projects, identify trends and emerging issues, recommend solutions and ensure timely, complete responses to business partners and senior leaders.

Focus on process improvement and standardization - ensuring the coordination of the components of the provider experience

Deploys a proactive and consultative approach to providing strategic thought leadership to identify and address complex issues

Analyze and measure the effectiveness of existing business processes and develop sustainable, repeatable and quantifiable business process improvements

Identify trends, conduct risk assessments, and identify areas of improvement resulting from information obtained through business partners

Research best practices and determine how technology can support re-engineering business processes

Review processes regularly to identify areas of improvement

Collaborate with key Medicaid business partners, including: Contracting, Credentialing, Referral/Authorizations, Claims, Grievance and Appeals, Market leadership, etc.

Required Qualifications

Minimum of a Bachelor's degree in Business, Healthcare, or related field and/or 8 years of equivalent job experience

5 years' experience in the Healthcare Industry

2 years of professional knowledge of provider value stream work: contracting, claims, and/or provider relations

Data trending and analysis experience

Proficient in MS Office

Highly motivated to grow process improvement knowledge and skills

Ability to identify problems, uncover efficiencies and implement process improvements

Self-starter and critical thinker

Stellar communication skills and ability to positively influence others

Able to exercise considerable independent judgment and initiative

Passionate about contributing to an organization focused on continuously improving

Work At Home requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

5 years' experience in Medicaid or another Government program

Previous experience in leading cross-functional teams on large-scale projects

PMP Certification

Six Sigma Certification

Additional information

Schedule: Monday to Friday from 8 am to 5 pm. Alternative schedule possible.

Training: Training is ongoing, there is some virtual foundational trainings that will take place within the first few weeks

Work Location (Address): Waterfront Plaza, Louisville KY, or WAH nationwide

% Travel: Less than 10%

Scheduled Weekly Hours

40

Company info

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