Lead, Medicaid Provider Services Implementation Specialist

1 month ago


Springfield, Illinois, United States Humana Full time
Job Summary

Humana is seeking a highly skilled Lead, Medicaid Provider Services Implementation to support the implementation of provider services business functions in new Medicaid markets. The successful candidate will be responsible for creating and implementing processes and solutions for non-standard contract requirements, resolving complex technical and operational challenges, and standing up provider services functions and other business functions in new Medicaid markets.

Key Responsibilities:

  • Develop and implement effective provider services business functions in new Medicaid markets, including local market provider services department staffing and standard operating procedure development.
  • Partner with cross-functional teams to ensure new Medicaid markets deliver best-in-class provider experiences and are compliant with all related contractual requirements.
  • Assist with hiring of new market Provider Services department leadership and serve as a mentor through post-go-live transition.
  • Facilitate workgroup calls/meetings/discussions for provider services action plan development.
  • Create and manage project plans to ensure effective and timely market rollouts.
  • Serve as subject matter expert and provide oversight of development of solutions to relevant non-standard contractual requirements and/or local needs of each Medicaid market.

Requirements:

  • 3+ years of Medicaid experience.
  • 5+ years of experience with health plan operations, provider services, and provider relations.
  • Proven expertise in driving operational efficiencies and management of timelines and processes.
  • Exceptional time management and ability to manage multiple priorities in a fast-paced environment.

Work Environment:

Humana is a remote-friendly company, and this role will require working hours within the Eastern Standard Time Zone. The successful candidate will be expected to work from a dedicated space with a reliable internet connection and a download speed of at least 25 Mbps and an upload speed of at least 10 Mbps.



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