Lead Medicaid Provider Services Implementation Specialist

1 day ago

Richmond, Virginia, United States Humana Full time
Job Summary

We are seeking a highly skilled and experienced Lead, Medicaid Provider Services Implementation, to join our team at Humana. As a key member of our implementation team, you will be responsible for leading the implementation of provider services functions in new Medicaid markets, ensuring timely and effective delivery of best-in-class provider experiences.

Key Responsibilities
  • Lead the implementation of provider services business functions in new Medicaid markets, including local market provider services department staffing and standard operating procedure development.
  • Partner cross-functionally 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, prioritizing work and escalating risks or barriers as needed.
  • Serve as a subject matter expert and provide oversight of development of solutions to relevant non-standard contractual requirements and/or local needs of each Medicaid market.
  • Engage in all new market implementations, including understanding contract provisions, to support and guide team members on priorities and help them manage risks and escalations.
  • Improve standard operating procedures over time to drive efficiencies and repeatable processes for new market implementations.
  • Cultivate strong working relationships with matrixed organization partners, including operational/shared services areas, needed to support provider services implementations.
Requirements
  • Must work hours within the Eastern Standard Time Zone.
  • Bachelor's Degree.
  • 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

This is a remote position, requiring a dedicated workspace with a reliable internet connection. Humana will provide the necessary equipment and support to ensure a productive and efficient work environment.

About Humana

Humana is a leading health and well-being company, committed to putting health first for our teammates, customers, and communities. We offer a comprehensive benefits package, competitive pay, and opportunities for professional growth and development.

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