Provider Data Management and Contract Load Professional

Employment Type: Full-time

Position Overview

Humana is seeking a Provider Data Management and Contract Load Professional to support the North and Central Medicaid and Medicare markets. This role performs data maintenance for the Provider Data Management System (PDMS) and supports various functions within the Medicaid and Medicare Market for all lines of business, including Medicare DSNP, Medicaid, and Long-term Care. The position is crucial for supporting Provider Network Development and Credentialing.

The Provider Data Management & Contract Load Professional 1 is responsible for the set-up, database loading, and preparation of administrative documents and materials. This role also provides support to provider accounts by responding to inquiries and resolving issues.

Responsibilities

• Maintains accurate, up-to-date provider data in the Provider Data Management System (PDMS).
• Collaborates with other staff to ensure all provider update requests (adds, changes, deletes) are researched, analyzed, responded to, and completed accurately and in a timely manner.
• Creates Provider records in the PDMS from received applications.
• Maintains standards for database integrity and quality assurance.
• Enters provider demographic information for requests within the PDMS.
• Works collaboratively with other departments regarding Provider updates.
• Assists with ad hoc projects.

Requirements

• Prior health care industry experience.
• Knowledge and intermediate experience of Microsoft Office applications, including Access, Excel, and Word.
• Excellent written and verbal communication skills.
• Keen attention to detail.
• Strong organizational and critical thinking skills.

Preferred Qualifications

• Associate's or higher-level degree.
• Prior health care industry experience in contracting or operations.
• Experience in APEX, CAS, MTV, PIMs, and claims process.

Additional Information

• Commitment: 18-month commitment.
• Workstyle: Remote. While the role is remote, there may be an expectation to use Humana office space on an as-needed basis for collaboration and other face-to-face needs.
• Typical Work Days/Hours: Must be available to start between business hours of 6:00 AM - 9:00 AM Monday – Friday, Eastern Standard Time (EST).

Work from Home/Remote Requirements

To ensure associates can work effectively, self-provided internet service must meet the following criteria:

• Recommended Speed: A minimum download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications.
• Connection Type: Wireless, Wired Cable, or DSL connection is suggested. Satellite, cellular, and microwave connections may be used only if they provide an optimal connection and are approved by leadership.
• Internet Cost: Humana will not pay for or reimburse associates for any portion of their self-provided internet service, with the exception of associates who live or work from home in California, Illinois, Montana, or South Dakota. These associates will receive a bi-weekly payment for their internet expense.
• Equipment: Humana will provide associates with telephone equipment appropriate to meet the business requirements for their position/job.

Company Information

Humana offers industry-leading benefits for all employees starting on their first day of employment, including:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO (including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time)
• And more

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