Indiana Medicaid Provider Services Director

Humana; Indianapolis (IN); Presencial; USD 139.000 - 191.000; Jornada completa

Descripción de la vacante

Humana is seeking a Director for Indiana Medicaid Provider Services to lead a team focused on provider relations, training, and claims education. The role drives strategic direction for provider networks and ensures timely state reporting and compliance.

The ideal candidate has extensive leadership experience in provider contracting, a strong understanding of Indiana Medicaid requirements, and a willingness to travel and relocate to Indiana as needed.

Formación

• Master’s Degree or equivalent experience.
• 8+ years Provider Contracting or Relations experience.
• Knowledgeable on Federal/State contractual provider requirements.
• 5+ years of management experience.
• Project management and initiative oversight experience.
• Ability to travel.
• Knowledgeable on provider contracting and credentialing processes.
• Must be passionate about contributing to an organization focused on improving consumer experiences.
• Must Reside in Indiana and will attend meetings in the Indianapolis office.

Responsabilidades

• Set strategic direction for and oversee main departments, including provider relations and training, claims analysis and education, provider payment performance, and practice transformation
• Develop operational procedures to align with the provider services model and execute on strategic programs within the provider network
• Grow positive, long-term relationships with LTSS/HCBS providers to foster provider retention and improve financial and quality performance
• Provide Indiana market oversight and governance of provider audits, surveys, service and relations, and provider feedback
• Review reports on provider complaints data and trends, claims denials/rework data and trends, provider training and communications, and provider performance data
• Represent the provider services team at state meetings and meet with main providers and provider associations
• Ensure team’s compliance with Indiana’s Managed Care Contractual requirements for provider relations, such as claims dispute resolution within specified timeframes
• Set and monitor team measurements and strategic goals
• Work with enterprise teams on provider call center, claims processing, reporting, contracting/credentialing, network adequacy, provider dispute resolution issues
• Plan and build regular and ad hoc provider communications and strategy for provider training
• Conduct regular performance evaluation of employees and provide ongoing feedback to achieve service, quality, and production goals; identify and support professional development for their team

Conocimientos

Provider relations

Contracting

Leadership

Project management

Travel flexibility

Credentialing processes

Educación

Master’s degree or equivalent experience

Descripción del empleo

Humana is seeking a Director for Indiana Medicaid Provider Services to lead a team focused on provider relations, training, and claims education. The role drives strategic direction for provider networks and ensures timely state reporting and compliance.

The ideal candidate has extensive leadership experience in provider contracting, a strong understanding of Indiana Medicaid requirements, and a willingness to travel and relocate to Indiana as needed.