Humana Hiring for Provider Data Management & Contract Load Professional at Naples Full Time

Description

Provider Data Management & Contract Load Professional 2 is responsible for administering the installation of assigned provider accounts. The Provider Data Management & Contract Load Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Provider Data Management & Contract Load Professional 2 performs the following:

• Set-up, database loading, and preparation of administrative documents and materials.

• Provides support to provider accounts for Humana Government Business (HGB) by responding to inquiries, and resolving issues of concern.

• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

• Follows established guidelines/procedures.

• Perform telephonic outreach to provider offices to verify the accuracy of reports.

Required Qualifications

Our Department of Defense contract requires U.S. citizenship for this position

Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)

Provider contract administration experience related to contract loading, directories and claims payment

Intermediate experience using Microsoft Word, Excel, and Access

Strong verbal and written communication skills

Able to present material to internal leadership teams

Analytical Thinking – ability to assess risk, resolve problems in a logical and systematic manner

Conceptual thinking – ability to identify patterns/connections/underlying themes that lead to understanding and resolving problems

Additional Requirements/Adherence:

Workstyle: Remote Work at Home

Location: United States

Hours: Must be able to work an 8 hour schedule between the hours of 7:30-5:00 Monday through Friday.

Travel: None

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.

• Satellite and Wireless Internet service is NOT allowed for this role.

• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Covid Policy

• For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

• If progressed to offer, you will be required to: Provide proof of full vaccination, including booster or commit to testing protocols OR   Provide proof of applicable exemption including any required supporting documentation

• ​​Medical, religious, state and remote-only work exemptions are available.

Preferred Qualifications

• Associate’s or Bachelor’s Degree

• Expertise in APEX, Claims processing, CAS, MTV and PIMS

• Expertise in claims processing

• Understanding of relational databases.

• Ability to explore databases, identify relationships and validate sources.

Additional Information

Scheduled Weekly Hours

40