Director, Provider Engagement

Humana•Indianapolis, IN

1d•$138,900 - $191,000

About The Position

The Director, Indiana Medicaid Provider Services, leads teams responsible for building positive, long-term relationships with LTSS and HCBS providers, improving provider experience and retention, supporting accurate and timely provider claims, and promoting high-quality care and stronger financial and quality performance. This senior market leader oversees direct and indirect reports across provider relations and training, claims analysis and education, provider payment performance, and practice transformation, and sets strategic direction for those departments. The role develops operating procedures and strategic programs for the provider network, provides Indiana market oversight of audits, surveys, provider relations, and feedback, and ensures provider services meet contractual requirements, including timely and accurate state reporting and claims dispute resolution. The Director reviews provider complaints, claims denials and rework, communications and training, and provider performance data to monitor results and guide improvements. They represent the team in state meetings and with major providers and provider associations, and collaborate with enterprise teams on provider call center operations, claims, reporting, contracting and credentialing, network adequacy, dispute resolution, and provider performance tools. The Director plans provider communications and training, sets and monitors team goals and measurements, and evaluates employees while providing ongoing feedback and supporting professional development. This position is dedicated to the Indiana Medicaid plan. The employee must reside in Indiana and attend meetings in the Indianapolis office; travel is required.

Requirements

Master's degree or equivalent experience.
At least 8 years of provider contracting or provider relations experience.
Knowledge of federal and state contractual provider requirements.
At least 5 years of management experience.
Project management and initiative oversight experience.
Ability to travel.
Knowledge of provider contracting and credentialing processes.
Must reside in Indiana and attend meetings in the Indianapolis office.
Passion for contributing to an organization focused on improving consumer experiences.

Nice To Haves

Prior experience in the health solutions industry, including expertise directing and leading teams.
Proficiency in quality improvement processes and financial trend analysis.

Responsibilities

Set strategic direction for and oversee provider relations and training, claims analysis and education, provider payment performance, and practice transformation.
Develop operational procedures aligned with the provider services model and execute strategic programs within the provider network.
Build positive, long-term relationships with LTSS and HCBS providers to support retention and improve financial and quality performance.
Provide Indiana market oversight and governance of provider audits, provider surveys, provider services and relations, and provider feedback.
Review provider complaint data and trends, claims denial and rework data and trends, provider training and communications, and provider performance data to monitor results and guide improvements.
Represent the provider services team at state meetings and meet with major providers and provider associations.
Ensure compliance with Indiana managed care contractual requirements for provider relations, including claims dispute resolution timeframes.
Set and monitor team measurements and strategic goals.
Work with enterprise teams on provider call center, claims processing, reporting, contracting and credentialing, network adequacy, provider dispute resolution, provider performance tracking, and tool enhancements.
Plan and develop regular and ad hoc provider communications and provider training strategy.
Conduct employee performance evaluations, provide ongoing feedback, and support professional development to improve engagement and performance.