Lead Medicaid Provider Services Implementation Specialist

3 weeks ago


Providence, Rhode Island, United States Humana Full time
Job Summary

We are seeking a highly skilled Lead Medicaid Provider Services Implementation professional to join our team at Humana. As a key member of our organization, you will be responsible for implementing and managing provider services functions in new Medicaid markets, ensuring compliance with contractual requirements and delivering best-in-class provider experiences.

Key Responsibilities
  • Develop and implement effective provider services business functions in new Medicaid markets, including staffing, standard operating procedure development, and provider education materials.
  • Partner with cross-functional teams to ensure new Medicaid markets meet contractual requirements and deliver exceptional provider experiences.
  • Assist with hiring and mentoring new market Provider Services department leadership.
  • Facilitate workgroup calls and meetings to develop provider services action plans.
  • Create and manage project plans to ensure timely market rollouts and prioritize work to mitigate risks.
  • Serve as a subject matter expert and provide oversight of solutions to non-standard contractual requirements.
  • Engage in new market implementations, understanding contract provisions, and guide team members on priorities and risk management.
  • Improve standard operating procedures to drive efficiencies and repeatable processes for new market implementations.
  • Cultivate strong working relationships with matrixed organization partners 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 managing timelines and processes.
  • Exceptional time management and ability to manage multiple priorities in a fast-paced environment.
Work Environment

This role is eligible for a bonus incentive plan and offers a competitive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and more. As a remote worker, you will have the flexibility to work from a dedicated space with a minimum download speed of 25 Mbps and an upload speed of 10 Mbps.

Humana is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating a workplace that is inclusive and respectful of all employees.



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