Manager Medicaid Provider Operations/Claims Research amp Resolution- Work at Home FL

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Job Information

Humana

Manager, Medicaid Provider Operations/Claims Research & Resolution- Work at Home FL

in

Tampa

Florida

Description

The Manager, Claims Research & Resolution manages the daily operations that involve provider contact for escalated issues, and oversight of the team performing investigation and review of operational issues impacting accurate claims processing for Florida Medicaid. The Manager, Claims Research & Resolution develops the strategy and processes required to meet the initiatives of the team; applies advanced technical knowledge to root cause and solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Claims Research & Resolution/Medicaid Provider Operations works with external agencies (such as the Florida State Agency), providers, and billing offices in the resolution of claims and other provider operational issues. This individual will create and maintain a positive relationship with the provider community by communicating updates and changes that are impactful to them, and facilitates education and resolution of provider issues. They will serve as a knowledge and resource expert for the most complex provider issues and understand and mitigate issues impacting provider satisfaction. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross-departmental collaboration to understand and resolve provider issues for prompt resolution, and maintains frequent contact with other managers and directors across the organization. The Manager, Claims Research & Resolution/Medicaid Provider Operations will attend Joint Operations Committees (JOC) to provide expertise and awareness of issues or updates on resolution, conduct routine claim and trend analysis, and is responsible for monitoring department metrics and oversight of daily activities.

Required Qualifications

Bachelor's Degree and/or a minimum of 6 years of equivalent job experience

6 years of Claims and/or Provider Resolution experience

3 years of Florida Medicaid experience

5 years of Managed Medicare/Medicaid experience

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Work At Home requirements:

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

COVID Vaccination

: We will require full COVID vaccination for this job as 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 or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Preferred Qualifications

2 years of management experience

Internal Humana Claims Knowledge

Additional information

Schedule:

Monday to Friday from 8 am to 5 pm.

Training:

Depends on the skills of the new hire; a few days to several weeks at minimum, and can be remote.

Work Location (Address):

Work At Home Florida

% Travel:

Minimal

# of Direct Reports:

Between 2-6

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com