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  • Market Network Operations Lead (Behavioral Health/Medicaid)

    Humana • Metairie, LA 70001

    Job #2289615986

  • Description

    The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Network Operations Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

    Responsibilities

    The Network Operations Lead 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 manages provider perceived service failures. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

    Required Qualifications

    • Bachelor's Degree or 3 or more years of provider contracting or physician network development experience

    • Experience with analyzing, understanding and communicating financial trends

    • 2 or more years of project leadership experience

    • Intermediate knowledge of Microsoft Word and Excel

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

    Preferred Qualifications

    • Experience with credentialing and contract management systems

    • Working knowledge in the areas of Group Practice Management, Long-Term Acute Care, home health, home infusion, behavioral health, ambulatory surgery, and the outpatient experience

    Work-At-Home Requirements

    • Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

    • A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

    • Satellite and Wireless Internet service is NOT allowed for this role.

    • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

    Scheduled Weekly Hours

    40

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