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Provider Data Management and Contract Load Professional

Humana

Humana

Data Science
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Posted on Wednesday, July 3, 2024

Become a part of our caring community and help us put health first

Humana is seeking a Provider Data Management and Contract Load Professional to support the Wisconsin Medicaid market. This position performs data maintenance for Provider Data Management System and supports various functions within the WI Medicaid Market for all lines of business (Medicare DSNP, Medicaid, and Long term Care), including but not necessarily limited to supporting Provider Network Development and Credentialing.
  • Maintains accurate, up to date provider data in the Provider Data Management System (PDMS).
  • Works in collaboration with other staff to ensure that all provider updates (adds, changes, delete) requests are researched, analyzed, responded to, and completed in an accurate and timely manner.
  • Creates Provider records in the PDMS from received applications.
  • Maintains standards for database integrity and quality assurance.
  • Outreach to practitioners on unreturned applications.
  • Updates practitioner rosters within Provider Data Management System for delegated credentialing agreements.
  • Generates recredentialing applications and conducts follow up with organizational providers on unreturned applications.
  • Enters provider demographic information for Prior Authorization requests within the PDMS.
  • Provides feedback to reduce errors and improve processes and performance; coordinates corrective activities.
  • Works collaboratively with other departments regarding database improvements and updates.
  • Participates in the preparation required for regulatory and internal reporting and the Provider Directory.
  • Represents the department on pertinent internal committees and appropriate meetings.
  • Maintains and responds to department e-mail inboxes.
  • Generates monthly ongoing monitoring reports identifying licensure and certification renewals and performs outreach to providers and organizations ensuring licensure or certification has been renewed.
  • Assists with ad hoc projects.


Use your skills to make an impact

Required Qualifications

  • Associate degree and 1 or more years of experience in a business or health care environment working with provider files or the collection and coordination of practitioner data OR 2 years of the same experience.
  • Proficiency with computer software programs such as Microsoft Excel, Word and ability to understand and learn new information systems and software programs.
  • Experience interacting effectively with healthcare providers.


Preferred Qualifications

  • Prior work experience and knowledge of Long Term Care, Medical, Behavioral Health, and Ancillary providers.
  • Bachelor’s degree.

Additional Information

  • Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
  • Typical Work days/hours: must be available Monday – Friday, 8:00 am – 5:00 pm Central Standard Time (CST)

WAH Internet Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

  • Health benefits effective day 1
  • Paid time off, holidays, volunteer time and jury duty pay
  • Recognition pay
  • 401(k) retirement savings plan with employer match
  • Tuition assistance
  • Scholarships for eligible dependents
  • Parental and caregiver leave
  • Employee charity matching program
  • Network Resource Groups (NRGs)
  • Career development opportunities

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.


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.


$44,200 - $60,900 per year


Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.