[Remote] Provider Data Management and Contract Load Professional at Humana

Wisconsin, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Associate degree and 1+ 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

Responsibilities

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
Generates monthly ongoing monitoring reports identifying licensure and certification renewals and performs outreach to providers and organizations ensuring licensure or certification has been renewed

Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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