MONTGOMERY, AL Humana
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Become a part of our caring community and help us put health first
Humana Military, a wholly owned subsidiary of Humana Inc (A $100 billion, Fortune 38 market leader in integrated healthcare), works with the federal government to provide high-quality service and cost-effective platforms to support the needs of current and former military members, and their families. Since 1996, Humana Military has served the Department of Defense (DoD) through the TRICARE health program. Through our support of TRICARE and other military and Veterans-focused healthcare programs over three decades, we have stood as an essential partner to the government to provide better health outcomes and simplified experiences for millions across the United States who have earned the best care possible in recognition of their service.
The Associate Vice President (AVP) of Provider Data maintains responsibility for the timely update and accurate representation of provider demographic and contracted rate information to ensure an up-to-date provider directory as well as appropriate claims adjudication impacting a multitude of downstream efforts to include (Referrals, Call Center, Market Operations, etc…). This position will maintain responsibility for data architecture and re-design, data steward program development, and deployment to better serve the TRICARE provider network population, as well as internal business constituents. The Associate Vice President (AVP) of Provider Data will maintain responsibility for partnering with 3rd party data validation, audit, and process improvement, to exceed contractual online directory contract guarantees.
The AVP of Provider Data will be responsible to drive strategy and full-cycle identification, design, implementation, management, measurement and continuous improvement for Provider Network Operations.
The AVP of Provider Data oversees 3 direct reports and a team of 80 FTEs + contractors. The position can be located anywhere in the lower 48 states.
The AVP will provide business intelligence and strategic planning in support of these operational areas Through (a) identifying best ways to operationalize contract change orders, (b) building and creating a culture of automation and digital adoption; identifying new opportunities for automation (c) actively introduce change management principles, (d) drive data-driven decision making in the following areas of responsibility:
Provider Data Management
Lead a team of tenured Provider Data and Process Business Intelligence Engineers and associates who consult, collaborate and manage with both internal and external. organizations/agencies on best practices for provider data exchanges, provider setups within Humana’s core systems, and usage of provider data for successful outcomes.
Oversees and implements strategic plans, drives goals/objectives, and provides input into Provider Process and Network Operations’ (PNO) Humana Government implementation strategy. Monitors progress and performance against the plan, taking action to resolve operational problems and minimize delays, and works with key leaders in PNO and Humana Government Business (HGB) to gather the resources to complete the implementation.
Knowledge and skills to develop and maintain a true Data Steward Program within HGB.
Coach and execute development, execution, and implementation of provider processes to create administrative cost savings for Humana.
Credentialing and Certification
Focus efforts on automation in order to increase speed to throughput for provider certification applications. Partnering through Artificial Intelligence in order to reduce manual process efforts.
Processes certification applications through an automated, application.
A. Implement process re-design in order to decrease administrative burden on provider community.
Ensure compliance with HGB, TRICARE, and URAC credentialing requirements.
Annual Defense Health Agency (DHA) and Triennial URAC credentialing compliance audits.
Process Improvement and Quality
Partner with HGB leadership to redesign and initiate process modification in order to ensure data accuracy within downstream systems.
Measuring the effectiveness of existing business processes – creating workflows, step actions, and documenting processes within PNO.
Trending and monitoring provider data – make recommendations for improvement of provider data quality across the HGB enterprise, including PGBA (3rd party claims adjudicator).
Liaison with external and internal business partners for provider certification escalations.
KEY ACCOUNTABILITIES
50% Provider Data architecture redesign and process improvement to improve quality and capability to absorb and disseminate within data repository systems and downstream impacts.
30% Provider Credentialing and Certification automation and redesign in order to speed application processing and timely completion in order to bring providers to a fully contracted status.
15% Team and process improvement redesign to reduce administrative burden placed upon the TRICARE provider community.
5% The ability to work cross-functionally to ensure provider data is utilized across the organization effectively and efficiently.
This position description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives .
Use your skills to make an impact
Required Qualifications
Bachelor’s degree.
5 or more years of leadership experience within a highly matrixed company (Ideally leading business areas of over 50 or more associates).
5 or more years of provider data process experience (Ideally leading strategy/processes, data engineering/intelligence, enhancing and streamlining data workflows, automation or data process redesign etc..).
Demonstrated Business and Financial acumen (Budget oversight, Complex ROI, Risk/Reward, Financial reporting) with established frameworks/processes to create both effective business case and translate strategy into scaled, financially viable programs.
Excellent communication and presentation skills to include the ability to communicate and present technical details to Senior VP level leadership and/or Senior Government officials.
Ability to work with project stakeholders, regional teams and clinical leaders at all levels in the organization in a collaborative, team environment.
Experience collaborating and building relationships with 3rd party vendors.
Our Department of Defense Contract requires U.S. citizenship for this position.
Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS).
HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
Preferred Qualifications
Experience with TRICARE policies and/or the military health care delivery system.
Experience in Agile transformation and process redesign or Agile Transformation Certification.
Experience in analyzing information, researching problems, and determining and implementing solutions.
Organizational skills necessary to effectively manage multiple activities.
Travel: While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$184,800 – $254,100 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 04-25-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana?to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
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MONTGOMERY, AL
