Humana - Boston, MA
posted 2 months ago
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.