Job Description:
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Role: Provider Network Operations Consultant
Location: Louisville, KY

Are you a fit?
Are you an expert on Medicare claims policies and procedures? Do you know how a Medicare Administrative Contractor operates? Would you enjoy leading special projects to analyze and improve Medicare Advantage processes and operations?

Assignment Capsule
As a Medicare Payment Policy Business Consultant you will serve as a subject matter expert lead on special projects related to the administration of Medicare Advantage plans.

• Consult with other business areas to create cost/benefit analyses and prioritize current projects
  
• Collect, analyze, and communicate competitive intelligence to influence operational strategies
  
• Prepare and present recommendations to both internal and external audiences

• Builds Trust: You honor your word by doing what you say you are going to do.
  
• Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
  
• Innovate: You introduce new ideas and processes which improve performance and productivity.
  
• Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

• Strong Medicare knowledge
  
• Bachelors degree in Business, Economics, Finance or a related field
  
• Exceptional written and verbal communication skills (writing sample will be requested during interview process)
  
• Prior working experience with a Medicare Fiscal Intermediary, carrier, or MAC
  
• Knowledge of multiple types of Current Procedural Terminology and Healthcare Common Procedure coding systems
  
• Comprehensive knowledge of Microsoft Word, Excel and/or Access

• Master's Degree in Business or a related fields
  
• Experience with a wide range of functions in managed care including provider contracting

• You will report to a PNO Manager. This area is under the direction of a Process owner in the Claims Process Organization.