KY Medicaid - Market Network Operations Lead Behavioral Health

Profile

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 behavioral health provider data for health plans including but not limited to adequacy, accessibility, demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures, including response to state inquiries and provider/member complaints. Drives to root cause and subsequent resolution with significant engagement with internal departments. Works closely with Kentucky Medicaid market operational leadership team to ensure regulatory adherence, process improvement and reduction in provider friction points. 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

3 or more years of provider contracting, provider relations or physician network development experience

Experience with analyzing, understanding and communicating financial trends

Strong process orientation and experience implementing process improvement initiatives

Significant understanding of Medicaid regulatory compliance

Intermediate knowledge of Microsoft Word and Excel

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

Must have valid driver's license with reliable transportation and the ability to travel within the Kentucky market up to 20% of the time.

Preferred Qualifications

Experience working in the Kentucky Medicaid market

Experience working in a leadership or mentoring role

Experience with credentialing and contract management systems

Working knowledge in the area of behavioral health

Additional Information

This position will be remote/work at home, however, the candidate must live within the region to be considered for this role.

Scheduled Weekly Hours

40

Company info

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