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COMPLETE Medicaid Behavioral Health Contract Load Professional - Remote US

3 days ago


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Job Opportunity Details

Type

Full Time

Salary

Not Telling

Work from home

No

Weekly Working Hours

Not Telling

Positions

Not Telling

Working Location

Remote US, Remote Nationwide, United States   [ View map ]

Become a part of our caring community and help us put health first
 

Are you interested in working in a fast paced operational environment? Do you like to stay busy and learn new skills every day? If so, this is the role for you! The Consumer Service Operations role is responsible for working inquiries from multiple service areas and supporting provider installation quality outcomes.

The Senior Consumer Service Operations Professional work assignments are complex in nature, performing in depth analysis of data and workflow scenarios, incorporating the evaluation of varying factors to achieve resolution. Some of the daily duties include; performing research, issue resolution, provider and market support, claims review and participation in project/initiative implementations.   

In addition, the Consumer Service Operations role within PCL is responsible for providing strategic and tactical solutions to acute issues and promote improvement opportunities. Multiple tools and forums will be utilized such as, but not limited to, IMS Intake, Zync, CRM,  Pre/Post calls and market collaboration forums.  The role will function as an expert on PCL processes and policies, provider setup and systems such as PAAG, PMDM and payer systems.

The Consumer Service Operations role keeps the provider and member in mind as they conduct business. The end goal is to help ensure a positive provider and member experience as it pertains to ensuring accurate and timely provider installation.

•            Solutions are fulfilled through use of various tools and formats such as IMS PCL Intake, Zync, CRM and Preload and Post-Load contributions.

•            The Analyst role will function as an expert on PCL processes and policies, provider setup, and systems such as PAAG, PMDM, CAS & MTV.

•            Analysts conduct research as needed related to issues such as, but not limited to, Executive Inquires, DOI complaints and G&A escalations.

•            Audits are performed by Analysts in the form of Peer Reviews, Pre Load and Post Load audits and CMS Finance Audits.

•            Provider Installation issues are researched and resolved via PCL Intake, CRMs and the PCP Database.

•            Analysts conduct monthly Collaboration Calls with their aligned market to present data sets illustrating trends related to submissions, routes, rejects and pertinent contract loading topics.

•            Analysts help drive automation opportunities for loads with groups of 25 or more physicians.


Use your skills to make an impact
 

Required Qualifications

  • Bachelor’s Degree or 3+ years of Provider Contract Load experience
  • 1+ years experience in demonstrating ability to analyze information, research problems, and determine and implement solutions
  • 3+ years experience in a service operations environment or related field
  • Behavioral Health provider experience (contracts, contract load, credentialing, or related field)
  • Prior Professional experience with Microsoft Suite, Word, Excel and PowerPoint
  • Meet Humana's Work at Home connectivity requirement listed in additional information.

Preferred Qualifications

  • Project Management Professional (PMP) certification
  • Six Sigma certification
  • Proficient with MS Access, Visio and Project
  • CAS/MTV/PIMs knowledge

Additional information

Hours:  8-4:30 p

Training: 5 weeks

Location: Remote US

Virtual Pre-Screen

As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a Modern Hire interview.  In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.

Work at Home Connectivity Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
  • Wireless, Wired Cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
  • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota.  Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. 

If you have additional questions regarding this role posting, please send them to the Ask A Recruiter by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


 

$57,700 - $79,500 per year


 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.


More Information

Application Details

  • Organization Details
    004 Humana Insurance Company
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