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Job Information

Humana Senior Data Management and Contract Load - Work at home in Troy, Michigan

Description

The Senior Provider Data Management & Contract Load Professional is responsible for administering the installation of assigned provider accounts. The Senior Provider Data Management & Contract Load Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Senior Provider Data Management & Contract Load Professional –Work-At-Home in US

The Senior Provider Data Management & Contract Load Professional performs Network Build set-up, database loading, and preparation of administrative documents and materials. Provides support to provider accounts by responding to inquiries, and resolving issues of concern. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Maintain datasets which have to be evaluated for the necessary elements required for Provider Loads. These datasets come in various forms depending on the vendor.

  • Necessary procedures to load/maintain these rosters

  • develop transformation processes to get the data from whatever format the file was given into SQL Server

  • construct procedures to prepare the data for loading into our Contractual and Directory systems

  • construct procedures to ensure we are utilizing Physicians and Groups already in our systems (or) construct new Physicians and Groups

  • construct scripts to update the directories

  • Audit the load as well as the entire roster will be done to ensure everything is set up properly

  • On-going Monthly requirements

  • Receive rosters and determine, after comparison with previous roster, what is to be added, changed, or termed as we do not always receive updates, or, we only receive updates and would then construct a “new” roster based on these updates and the previous roster sent

  • Load/Update all Adds, Changes, and Terminations

  • Auditing Requirements

  • Provide evidence all Ids (Groups and Physicians) are accurate and according to guidelines

Required Qualifications

  • Bachelor's degree

  • Comprehensive knowledge of Microsoft Word and Excel

  • Intermediate to Advanced skills using SQL Server and Intermediate MS Access/VBA

  • Ability to write routine reports and correspondence

  • Ability to speak effectively before groups of customers or employees

  • Problem solving abilities

  • Self-motivated and task oriented

  • Able to prioritize assignments with little guidance

  • Excellent communication and interpersonal skills

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

Preferred Qualifications

  • Master's Degree

  • SSIS

  • Python

  • Experience resolving Provider reimbursement issues

  • Experience with Provider reimbursement

  • 4 or more years provider relations experience

  • 4 or more years of experience in a medical environment dealing with managed care/insurance issues; i.e. benefits, claims, etc.

Additional Information

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.

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