Director, Provider Activation

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 The Director, Provider Activation is responsible for the end-to-end process of adding providers to Humana’s network and maintaining payment terms so that claims are paid accurately and timely, for all provider types and all fee-for-service contracts. The role includes ownership of both internal and external functions that support provider activation, issue resolutions, and horizontal stakeholder / functional alignment (e.g. coordination with market NOCs who do not report directly to the provider activation team). This leader owns the day-to-day production of contract load, participates in the development of strategic plans to increase productivity, and oversees execution of relevant initiatives.

The Director, Provider Activation motivates, manages, and leads high-performance teams involved in preparing, processing, and sustaining provider contracts, contract upload, CIS selection, and fee schedule maintenance. Collaborates closely with operational and market leaders to resolve any escalation or conflict, acting as a single point of contact for provider activation issues. Maintains standard as the subject matter expert for all things provider activation across all group and provider types (e.g., ancillaries, hospital systems, individual providers, groups, facilities, FQHCs/RHCs). Works with compliance and quality assurance teams to ensure all relevant quality standards operational policies/procedures are aligned with the strategic objectives and ensures legislative and policy compliance relative to provider activation functions. Controls the continuous improvement roadmap for provider activation operations including identifying projects to improve. Will build and implement the strategy to partner with our vendors. Works closely with leadership to identify and report on SLAs and overall team performance against SLAs. Embraces and leads with digital ways of working and utilizes latest industry technologies and methodologies.

Use your skills to make an impact
 

Required Qualifications

• 5 or more years of leadership experience leading operation teams
• 5 or more years of provider contract administration experience related to directories and claims payment
• Bachelor’s Degree
• Strong knowledge in process improvement and data-driven performance management
• Execution-driven mindset with an openness to collaborate and present material to internal leadership teams
• Excellent verbal and written communications with the ability to align the organization on streamlined processes using various change management techniques

Preferred Qualifications

• 3 or more years of experience leading other leaders
• Knowledge of Humana's internal policies, procedures, and systems

Additional Information

Location: Remote US, prefer Louisville, KY area

Hours: Typical Business Hours (9am to 5pm EST respectively)

Travel Requirement: Up to 10% travel may …