Associate VP, Provider Data Position Available In Kennebec, Maine

Associate VP, Provider Data at Humana in Augusta, Maine, United States Job Description Become a part of our caring community and help us put health first Humana Military, a wholly owned subsidiary of Humana Inc (A $100 billion, Fortune 38 market leader in integrated healthcare), works with the federal government to provide high-quality service and cost-effective platforms to support the needs of current and former military members, and their families. Since 1996, Humana Military has served the Department of Defense (DoD) through the TRICARE health program. Through our support of TRICARE and other military and Veterans-focused healthcare programs over three decades, we have stood as an essential partner to the government to provide better health outcomes and simplified experiences for millions across the United States who have earned the best care possible in recognition of their service. The Associate Vice President (AVP) of Provider Data maintains responsibility for the timely update and accurate representation of provider demographic and contracted rate information to ensure an up-to-date provider directory as well as appropriate claims adjudication impacting a multitude of downstream efforts to include (Referrals, Call Center, Market Operations, etc…). This position will maintain responsibility for data architecture and re-design, data steward program development, and deployment to better serve the TRICARE provider network population, as well as internal business constituents. The Associate Vice President (AVP) of Provider Data will maintain responsibility for partnering with 3rd party data validation, audit, and process improvement, to exceed contractual online directory contract guarantees. The AVP of Provider Data will be responsible to drive strategy and full-cycle identification, design, implementation, management, measurement and continuous improvement for Provider Network Operations. The AVP of Provider Data oversees 3 direct reports and a team of 80 FTEs + contractors. The position can be located anywhere in the lower 48 states. The AVP will provide business intelligence and strategic planning in support of these operational areas Through (a) identifying best ways to operationalize contract change orders, (b) building and creating a culture of automation and digital adoption; identifying new opportunities for automation © actively introduce change management principles, (d) drive data-driven decision making in the following areas of responsibility: Provider Data Management + Lead a team of tenured Provider Data and Process Business Intelligence Engineers and associates who consult, collaborate and manage with both internal and external. organizations/agencies on best practices for provider data exchanges, provider setups within Humana’s core systems, and usage of provider data for successful outcomes. + Oversees and implements strategic plans, drives goals/objectives, and provides input into Provider Process and Network Operations’ (PNO) Humana Government implementation strategy. Monitors progress and performance against the plan, taking action to resolve operational problems and minimize delays, and works with key leaders in PNO and Humana Government Business (HGB) to gather the resources to complete the implementation. + Knowledge and skills to develop and maintain a true Data Steward Program within HGB. + Coach and execute development, execution, and implementation of provider processes to create administrative cost savings for Humana. Credentialing and Certification + Focus efforts on automation in order to increase speed to throughput for provider certification applications. Partnering through Artificial Intelligence in order to reduce manual process efforts. + Processes certification applications through an automated, application. + A. Implement process re-design in order to decrease administrative burden on provider community. + Ensure compliance with HGB, TRICARE, and URAC credentialing requirements. + Annual Defense Health Agency (DHA) and Triennial URAC credentialing compliance audits. Process Improvement and Quality + Partner with HGB leadership to redesign and initiate process modification in order to ensure data accuracy within downstream systems. + Measuring the effectiveness of existing business processes – creating workflows, step actions, and documenting processes within PNO. + Trending and monitoring provider data – make recommendations for improvement of provider data quality across the HGB enterprise, including PGBA (3rd party claims adjudicator). + Liaison with external and internal business partners for provider certification escalations.

KEY ACCOUNTABILITIES 50

% Provider Data architecture redesign and process improvement to improve quality and capability to absorb and disseminate within data repository systems and downstream impacts. 30% Provider Credentialing and Certification automation and redesign in order to speed application processing and timely completion in order to bring providers to a fully contracted status. 15% Team and process improvement redesign to reduce administrative burden placed upon the TRICARE provider community. 5% The ability to work cross-functionally to ensure provider data is utilized across the organization effectively and efficiently. This position description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives . Use your skills to make an impact Required Qualifications + Bachelor’s degree. + 5 or more years of leadership experience within a highly matrixed company (Ideally leading business areas of over 50 or more associates). + 5 or more years of provider data process experience (Ideally leading strategy/processes, data engineering/intelligence, enhancing and streamlining data workflows, automation or data process redesign etc..). + Demonstrated Business and Financial acumen (Budget oversight, Complex ROI, Risk/Reward, Financial reporting) with established frameworks/processes to create both effective business case and translate strategy into scaled, financially viable programs. + Excellent communication and presentation skills to include the ability to communicate and present technical details to Senior VP level leadership and/or Senior Government officials. + Ability to work with project stakeholders, regional teams and clinical leaders at all levels in the organization in a collaborative, team environment. + Experience collaborating and building relationships with 3rd party vendors. + Our Department of Defense Contract requires U.S. citizenship for this position. + Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS). + HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico. Preferred Qualifications + Experience with TRICARE policies and/or the military health care delivery system. + Experience in Agile transformation and process redesign or Agile Transformation Certification. + Experience in analyzing information, researching problems, and determining and implementing solutions. + Organizational skills necessary to effectively manage multiple activities.

Travel:

While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time