AVP, Provider Activation

Description

The AVP, 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 participates in the development of strategic plans to increase productivity and oversees execution of relevant initiatives.

Responsibilities

The AVP, Provider Activation motivates, manages, and leads high-performance teams involved in preparing, processing, and sustaining provider contracts, including credentialing, 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. 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.

               

Required Qualifications

• 10 or more years in the healthcare industry working in payor segment with experience in Provider Onboarding and Provider Relations Operations
• 10 or more years of leadership experience, including of front-line staff
• Working knowledge of process improvement and data-driven performance management
• Working knowledge of the latest workforce management tools and techniques
• Bachelor’s degree
• Execution-driven mindset with an openness to collaborate
• Excellent verbal and written communications with the ability to align the organization on streamlined processes using various change management techniques

Preferred Qualifications

• Advanced degree
• Ability to anticipate and be proactive around next steps in large initiatives simultaneously
• Broad understanding of our businesses and connectedness to key Humana constituent areas
• Knowledge of Humana's internal policies, procedures, and systems
• Experiencing implementing automation initiatives

Additional Information

• Hybrid office preferred location of either Louisville, KY or Green Bay, WI. Otherwise, remote work at home anywhere across the US will be considered. Work-At-Home 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; wireless, wired cable or DSL connection is suggested; Satellite, cellular and microwave connection can be used only if approved by leadership; Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense; Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job; Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Requires approximately 10% travel as business needs dictate

Scheduled Weekly Hours

40