KY Medicaid - Market Network Operations Lead (Behavioral Health)
Humana

Job Info

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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. Worksclosely with Kentucky Medicaid market operational leadership teamto 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 relationsor 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

This job has expired.