Director, Provider Engagement

Humana•Indianapolis, IN

About The Position

The Director, Indiana Medicaid Provider Services, is a senior market leader responsible for setting strategic direction and overseeing teams focused on provider relations and training, claims analysis and education, provider payment performance, provider engagement, and practice transformation. The role is dedicated to the Indiana Medicaid plan, and the employee must reside in Indiana or be willing to relocate there. The Director leads direct and indirect reports and represents the provider services team in state meetings and discussions with major providers and provider associations. The position oversees provider services operations to meet contractual requirements, ensure timely and accurate state reporting, and support positive, long-term relationships with LTSS/HCBS providers. The work aims to improve provider retention, provider experience, claims accuracy and timeliness, and the financial and quality performance of the network. The Director also collaborates with enterprise teams on provider call center operations, claims processing, reporting, contracting and credentialing, network adequacy, dispute resolution, provider performance tracking, and related tools. The Director sets and monitors team goals and measures, reviews operational and provider-performance data, and guides improvement efforts. The role includes employee performance evaluations, ongoing feedback, and professional development support. This position requires travel and attendance at meetings in the Indianapolis office. The stated schedule is 40 hours per week.

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.
Passion for contributing to an organization focused on improving consumer experiences.
Must reside in Indiana and attend meetings in the Indianapolis office.

Nice To Haves

Prior experience in the health solutions industry, with expertise directing and leading teams.
Proficiency in quality improvement processes and analyzing financial trends.

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 across the provider network.
Build positive, long-term relationships with LTSS/HCBS providers to support provider 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 complaints, claims denials and rework, provider training and communications, and provider performance data to monitor team performance and guide improvements.
Represent the provider services team at state meetings and meet with major providers and provider associations.
Ensure the team meets 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 regular and ad hoc provider communications and provider training strategies.
Conduct employee performance evaluations and provide ongoing feedback to achieve service, quality, and production goals.
Identify and support professional development to strengthen team engagement and performance.
Travel and attend meetings in the Indianapolis office.