The Director, Indiana Medicaid Provider Services, leads a team accountable for growing positive, long-term relationships with LTSS providers. We do this in order to foster positive provider experiences, submit accurate and timely provider claims, and deliver high-quality care among network providers. , this leads to improved financial and quality performance. This senior market leader will oversee a team of direct and indirect reports responsible for provider relations and training, claims education, provider engagement and practice transformation. They set strategic direction for those accountable departments. They represent the team at meetings with the state or main provider groups. They oversee provider services functions to meet contractual requirements and complete state reports timely and accurately. The Director, Provider Services, requires an in-depth understanding of how organization capabilities interrelate across the team, IN Medicaid market, and the enterprise. This is a dynamic role requiring experience. This position is dedicated to the Indiana Medicaid plan and must be based in or willing to relocate to Indiana.
- Set strategic direction for and oversee main departments, including provider relations and training, claims analysis and education, provider payment performance, and practice transformation
- Develop operational procedures to align with the provider services model and execute on strategic programs within the provider network
- Allow the growth of positive, long-term relationships with LTSS/HCBS providers to foster provider retention and improve financial and quality performance within the contracted working relationship with the health plan.
- Provide Indiana market oversight and governance of provider audits, provider surveys, provider service and relations, and provider feedback.
- Review reports provider complaints data and trends, claims denials/rework data and trends, provider training and communications, and provider performance data in order to monitor team performance and guide strategic Improvements where needed
- Represent the provider services team at all state meetings. Meet with main providers, and provider associations
- Ensure team's compliance with Indiana's Managed Care Contractual requirements for provider relations, such as claims dispute resolution within specified timeframes
- Set and monitor team measurements and strategic goals
- Work enterprise teams on provider call center, claims processing, reporting, contracting/credentialing, network adequacy, provider dispute resolution issues, and provider performance tracking and tool enhancements.
- Plan and build regular and ad hoc provider communications and strategy for provider training
- Conduct regular performance evaluation of employees and provide ongoing feedback to achieve service, quality, and production goals. Identify and support professional development for their team to grow associate engagement and performance
Use your skills to make an impact
Required Qualifications
- Master's Degree or equivalent experience
- 8 or more years Provider Contracting or Relations experience
- Knowledgeable on Federal/State contractual provider requirements
- 5 or more years of management experience
- Project management and initiative oversight experience
- Ability to travel
- Knowledgeable on provider contracting and credentialing processes
- Must be passionate about contributing to an organization focused on improving consumer experiences
- Must Reside in Indiana and will attend meetings in the Indianapolis office
Preferred Qualifications
- Prior work experience in the health solutions industry with expertise directing and leading teams
- Proficiency in quality improvement processes, analyzing financial trends
Additional Information
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$138,900 - $191,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 9Humana9) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
