Provider Network Filing and Adequacy Oversight Manager

Less than 5 years experience  •  Misc. Healthcare

Salary depends on experience
Posted on 11/20/17
Louisville, KY
Less than 5 years experience
Misc. Healthcare
Salary depends on experience
Posted on 11/20/17

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.    Assignment Capsule

As the Network Filing & Adequacy Reporting Manager you will collaborate with both internal and external business partners in order to optimize business results through leading a team of analysts and one consultant.

  • Build and manage relationships with Network and Retail Segment leadership
  • Review federal and state contracts for artifact, timeline, and process impacts
    • Oversee business process impact analysis and identify changes needing IT action
    • Ensure IT actions needed are documented and communicated to Systems team
    • Support the testing of new systems functionality to ensure optimal user experience
  • Develop and manage filing timelines for Medicare, Employer Group, and Medicaid programs
  • Support the development of training documentation for internal team members and end users
  • Act as liaison to compliance partners regarding filing artifact production timelines and policy adherence
  • Support user specific filing and reporting communications through consultants and team of analysts
  • Develop and manage processes to streamline operations with focus on user experience as well as team efficiency
  • Leverage reporting and tools to identify and communicate both progress and risks to senior leaders

Key Competencies

  • Accountability:  Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
  • Collaborates:  Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first.
  • Interpersonal Effectiveness:  Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships. 
  • Leads Change:  Guides and energizes others, models adaptability, and inspires strong organizational performance through periods of transformation, ambiguity, and complexity.

Role Essentials

  • Bachelor’s degree
  • 2+ years experience in the provider network/contracting space(managed care organization or provider organization)
  • Excellent communication skills, verbal,written and presentation
  • Experience with CMS and CMS audit protocol
  • Previous Supervisor experience
  • Demonstrated ability to deliver results in a fast-paced environment


Role Desirables               

  • Network Compliance Management with Medicare adequacy requirements experience
  • Knowledge of internal Humana systems


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