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Humana Inc.

Director Provider Administration

Humana Inc. - KY, USA

Director Provider Administration','186499','US-KY-Louisville','','Office','Office','Full-time','','!*!Role: Director, Provider Administration 

Assignment: Humana Military

Location:  Forum III, Louisville, KY


Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their families. For more than 20 years, Humana Military has strived to create better health outcomes and simplified experiences for millions of beneficiaries across the United States through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, and progressive approaches to care drive Humana Military to be a thought leader in the industry and an essential partner to the Government.

Assignment Capsule

Develops, implements, and controls the policies and procedures for the administration of contract loading and maintenance for over 500,000 network providers including hospital, physician, behavioral health and ancillary in support of HGB’s contract requirements. Responsible for oversight of subcontractor functions as related to provider data management to ensure the integrity of provider information through the process of accurate and timely provider file updates for the 1M TRICARE provider population (network and non-network). 

Responsible for the credentialing activities associated with the network which includes coordination with Humana Inc and delegated entities. Maintenance of these records in an accurate fashion is critical to the success of multiple operating arms of HGB including, but not limited to Claims Oversight, Provider Network Development, Billing and Enrollment, and Referral/Authorization processing.

Identifies and facilitates system requirements to make necessary enhancements to appropriate provider system.  Identifies and facilitates processes and improvements for data loading and maintenance. Coordinate change order driven updates to provider data systems used by HGB and subcontractors.  Coordination of services with outside vendor for maintenance of eVIPs provider system.

Key Accountabilities

Develop, implement, and controls the processes, policies and procedures used to ensure the accurate administration, use and illustration of provider information used throughout the HGB organization. 

Effectively and accurately manage the loading of provider contract terms to the claims processing system. 

Oversee the HGB provider credentialing operation to ensure timely and accurate processing of credentialing applications in addition to the effective management of delegated entities and relationships.

Ensure compliance with TRICARE policy and CFR regulations as it relates to provider certification and provider data management.

Ensure alignment and engagement with strategic planning for the improved management of provider data accuracy with the Humana enterprise. 

 ','!*!Role Essentials

Bachelor’s Degree

A minimum of 7 years of leadership and management experience in a Network Development, Government Contracts, or Business Development Management.

Ability to apply the principles of independent logical thinking to define problems, collect data, establish facts, draw valid conclusions, and make strategic recommendations.

Ability to integrate and coordinate content from various sources to establish deliverables for multiple stakeholders and hold others accountable for delivering.

Strong organization and prioritization skills

Strong verbal and written communication skills

Role Desirables

Graduate degree in Business or Health Care Administration

Previous experience with TRICARE contracts or Government Healthcare

Experience in the military health care delivery system

Reporting Relationships

This position reports to a Field Vice President.

Additional Information

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.','Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.','Director Provider Administration

7 days 7 hours ago

Humana Inc.


Director Provider Administration Humana Inc. - , KY, United States


Company Profile:
Humana's diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Find out how Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.