Associate Director Provider Relations Ohio Medicaid - Remote OH

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Job Information

Humana

Associate Director, Provider Relations (Ohio Medicaid) - Remote, OH

in

Cincinnati

Ohio

Description

Humana Healthy Horizons is seeking an Associate Director, Provider Relations who will oversee the Ohio Medicaid plan's provider relations team to ensure Perfect Experiences for its providers and compliance with provider relations requirements in the Ohio Department of Medicaid Managed Care Contract. The Associate Director is responsible for development of network provider training, education, leading external training events, establishing policies and operating procedures for provider relations representatives, and monitoring team performance against key performance indicators or contractual requirements. This is a collaborative role requiring critical thinking and problem solving skills, independence, leadership, a strategic mindset, and attention to detail. This position reports to the plan's Director, Provider Services.

Responsibilities

Establish policies and operating procedures for team of provider relations representatives.

Monitor all feedback from individual providers to inform improvements to Humana processes.

Develop provider training/orientation materials and timely communications of changes to the Ohio Department of Medicaid program.

Lead external provider training events, such as provider town halls.

Monitor team's performance against key performance indicators and contractual commitments and requirements. Work with health plan leadership to improve performance, as needed.

Represent the local market leadership in planning and strategy with internal corporate partners to ensure cross-department alignment and communication.

Work with internal corporate partners to develop and implement the claims dispute resolution process and ensure cross-department communication and resolution of provider's issues.

Ensure positive provider relationships and contribute to provider retention in Humana's Medicaid networks.

Onboard and train new provider relations team members.

Required Qualifications

Bachelor's Degree.

6 or more years of progressive experience in managed care operations, including network management and provider relations.

Experience in claims processing and payment and dispute resolution.

Knowledge of Microsoft Office applications.

Exceptional relationship management skills.

Excellent written and verbal communication skills and experience presenting to varied audiences.

Prior leadership and management experience.

Thorough understanding of managed care contracts, including contract language and reimbursement.

Ability to manage multiple priorities in a fast-paced environment.

Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured.

This role is 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.

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.

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Preferred Qualifications

Master's Degree.

Experience with the Ohio Medicaid MCO contract, including network adequacy requirements and standards for provider relations compliance.

Experience with value based contracting.

Additional Information

Direct Reports: up to 20 Associates.

Travel: up to 50% to provider offices and Humana Healthy Horizons location in Dublin, OH for meetings/trainings.

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.

Scheduled Weekly Hours

40

Company info

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