Medicaid Behavioral Health Contract Load Professional

Description

Are you interested in working in a fast paced operational environment? Do you like to stay busy and learn new skills every day? If so, this is the role for you! The Consumer Service Operations role is responsible for working inquiries from multiple service areas and supporting provider installation quality outcomes.

Responsibilities

The Senior Consumer Service Operations Professional work assignments are complex in nature, performing in depth analysis of data and workflow scenarios, incorporating the evaluation of varying factors to achieve resolution. Some of the daily duties include; performing research, issue resolution, provider and market support, claims review and participation in project/initiative implementations.   

In addition, the Consumer Service Operations role within PCL is responsible for providing strategic and tactical solutions to acute issues and promote improvement opportunities. Multiple tools and forums will be utilized such as, but not limited to, IMS Intake, Zync, CRM,  Pre/Post calls and market collaboration forums.  The role will function as an expert on PCL processes and policies, provider setup and systems such as PAAG, PMDM and payer systems.

The Consumer Service Operations role keeps the provider and member in mind as they conduct business. The end goal is to help ensure a positive provider and member experience as it pertains to ensuring accurate and timely provider installation.

•            Solutions are fulfilled through use of various tools and formats such as IMS PCL Intake, Zync, CRM and Preload and Post-Load contributions.

•            The Analyst role will function as an expert on PCL processes and policies, provider setup, and systems such as PAAG, PMDM, CAS & MTV.

•            Analysts conduct research as needed related to issues such as, but not limited to, Executive Inquires, DOI complaints and G&A escalations.

•            Audits are performed by Analysts in the form of Peer Reviews, Pre Load and Post Load audits and CMS Finance Audits.

•            Provider Installation issues are researched and resolved via PCL Intake, CRMs and the PCP Database.

•            Analysts conduct monthly Collaboration Calls with their aligned market to present data sets illustrating trends related to submissions, routes, rejects and pertinent contract loading topics.

•            Analysts help drive automation opportunities for loads with groups of 25 or more physicians.

               

Required Qualifications

• Bachelor’s Degree or 3+ years of Provider Contract Load experience
• 1+ years experience in demonstrating ability to analyze information, research problems, and determine and implement solutions
• 3+ years experience in a service operations environment or related field
• Behavioral Health provider experience (contracts, contract load, credentialing, or related field)
• Prior Professional experience with Microsoft Suite, Word, Excel and PowerPoint
• Meet Humana's Work at Home connectivity requirement listed in additional information.

Preferred Qualifications

• Project Management Professional (PMP) certification
• Six Sigma certification
• Proficient with MS Access, Visio and Project
• CAS/MTV/PIMs knowledge

Additional information

Hours:  8-4:30 p

Training: 5 weeks

Location: Remote KY/IN or Remote WI

Virtual Pre-Screen

As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a Modern Hire interview.  In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.

Work at Home Connectivity Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
• Wireless, Wired Cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
• Humana will not pay for or reimburse