Director, Network Operations

Company: Humana
Location: Billings
Posted on: June 8, 2021

Job Description:

About this job Description The Director, Network Operations maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Director, Network Operations requires an in-depth understanding of how organization capabilities interrelate across the function or segment. Responsibilities The Director, Network Operations manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supportingDescriptionThe Director, Network Operations maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Director, Network Operations requires an in-depth understanding of how organization capabilities interrelate across the function or segment.ResponsibilitiesThe Director, Network Operations manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy. Required Qualifications Bachelor's Degree8 or more years of technical experience5 or more years of management experienceStrong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arenaProven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologiesMust be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Experience with ACO/Risk ContractingMaster's Degree in Business Administration or Finance Additional Information Scheduled Weekly Hours40

Keywords: Humana, Billings , Director, Network Operations, Other , Billings, Montana