Director, Provider Activation
About the position
The Director, Provider Activation is a pivotal role within Humana, responsible for overseeing the comprehensive process of integrating providers into the network and ensuring that payment terms are maintained for accurate and timely claims processing across all provider types and fee-for-service contracts. This position encompasses both internal and external functions that facilitate provider activation, address issues, and ensure alignment among various stakeholders and functions, including coordination with market Network Operations Centers (NOCs) that do not report directly to the provider activation team. The Director will manage the daily operations related to contract loading, contribute to the development of strategic plans aimed at enhancing productivity, and supervise the execution of relevant initiatives. In this leadership role, the Director, Provider Activation will inspire and guide high-performance teams responsible for the preparation, processing, and maintenance of provider contracts, contract uploads, and fee schedule management. The position requires close collaboration with operational and market leaders to resolve escalations or conflicts, serving as the primary point of contact for provider activation issues. The Director will also act as the subject matter expert on provider activation across various groups and provider types, including ancillaries, hospital systems, individual providers, groups, facilities, and Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs). Additionally, the role involves working with compliance and quality assurance teams to ensure that all operational policies and procedures align with strategic objectives and comply with relevant legislation and policies regarding provider activation functions. The Director will be responsible for controlling the continuous improvement roadmap for provider activation operations, identifying projects aimed at enhancing efficiency. This role will also involve building and implementing strategies to partner with vendors and closely monitoring team performance against Service Level Agreements (SLAs). Embracing digital methodologies and leveraging the latest industry technologies will be essential in this position, as the Director leads the charge in modernizing provider activation processes.
Responsibilities
Oversee the end-to-end process of adding providers to Humana's network and maintaining payment terms.
,
Manage the day-to-day production of contract load and participate in strategic planning to increase productivity.
,
Lead high-performance teams involved in preparing, processing, and sustaining provider contracts.
,
Collaborate with operational and market leaders to resolve escalations or conflicts related to provider activation.
,
Act as the subject matter expert for provider activation across all group and provider types.
,
Work with compliance and quality assurance teams to ensure alignment with quality standards and legislative compliance.
,
Control the continuous improvement roadmap for provider activation operations and identify projects for improvement.
,
Build and implement strategies to partner with vendors and report on SLAs and team performance.
Requirements
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 openness to collaborate and present material to internal leadership teams.
,
Excellent verbal and written communication skills.
Nice-to-haves
3 or more years of experience leading other leaders.
,
Knowledge of Humana's internal policies, procedures, and systems.
Benefits
Medical, dental, and vision benefits
,
401(k) retirement savings plan
,
Paid time off including company and personal holidays
,
Volunteer time off
,
Paid parental and caregiver leave
,
Short-term and long-term disability
,
Life insurance
,
Various other opportunities for personal wellness and healthcare decisions
Apply Now
The Director, Provider Activation is a pivotal role within Humana, responsible for overseeing the comprehensive process of integrating providers into the network and ensuring that payment terms are maintained for accurate and timely claims processing across all provider types and fee-for-service contracts. This position encompasses both internal and external functions that facilitate provider activation, address issues, and ensure alignment among various stakeholders and functions, including coordination with market Network Operations Centers (NOCs) that do not report directly to the provider activation team. The Director will manage the daily operations related to contract loading, contribute to the development of strategic plans aimed at enhancing productivity, and supervise the execution of relevant initiatives. In this leadership role, the Director, Provider Activation will inspire and guide high-performance teams responsible for the preparation, processing, and maintenance of provider contracts, contract uploads, and fee schedule management. The position requires close collaboration with operational and market leaders to resolve escalations or conflicts, serving as the primary point of contact for provider activation issues. The Director will also act as the subject matter expert on provider activation across various groups and provider types, including ancillaries, hospital systems, individual providers, groups, facilities, and Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs). Additionally, the role involves working with compliance and quality assurance teams to ensure that all operational policies and procedures align with strategic objectives and comply with relevant legislation and policies regarding provider activation functions. The Director will be responsible for controlling the continuous improvement roadmap for provider activation operations, identifying projects aimed at enhancing efficiency. This role will also involve building and implementing strategies to partner with vendors and closely monitoring team performance against Service Level Agreements (SLAs). Embracing digital methodologies and leveraging the latest industry technologies will be essential in this position, as the Director leads the charge in modernizing provider activation processes.
Responsibilities
Oversee the end-to-end process of adding providers to Humana's network and maintaining payment terms.
,
Manage the day-to-day production of contract load and participate in strategic planning to increase productivity.
,
Lead high-performance teams involved in preparing, processing, and sustaining provider contracts.
,
Collaborate with operational and market leaders to resolve escalations or conflicts related to provider activation.
,
Act as the subject matter expert for provider activation across all group and provider types.
,
Work with compliance and quality assurance teams to ensure alignment with quality standards and legislative compliance.
,
Control the continuous improvement roadmap for provider activation operations and identify projects for improvement.
,
Build and implement strategies to partner with vendors and report on SLAs and team performance.
Requirements
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 openness to collaborate and present material to internal leadership teams.
,
Excellent verbal and written communication skills.
Nice-to-haves
3 or more years of experience leading other leaders.
,
Knowledge of Humana's internal policies, procedures, and systems.
Benefits
Medical, dental, and vision benefits
,
401(k) retirement savings plan
,
Paid time off including company and personal holidays
,
Volunteer time off
,
Paid parental and caregiver leave
,
Short-term and long-term disability
,
Life insurance
,
Various other opportunities for personal wellness and healthcare decisions
Apply Now