Medicaid Market Development Advisor - Remote US

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Job Information
Humana
Medicaid Market Development Advisor - Remote, US
in
Phoenix
Arizona
Description
The Market Development Advisor provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE/Employer Group product implementation, operations, contract compliance, and federal contract application submissions. The Market Development Advisor works on problems of diverse scope and complexity ranging from moderate to substantial. Within this role, the Market Development Advisor will oversee cross-functional teams and processes pertaining to the claims and encounter submission processes.
Responsibilities
The Market Development Advisor serves as the primary resource on regulations and operational oversight of encounter process submissions for all assigned health plans.
Ensures that assigned health plans are meeting or exceeding corporate Medicaid performance benchmarks.
Maintains relationships with regulators and state operational leaders.
Advises executives to develop functional strategies (often segment specific) on matters of significance.
Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.
Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Required Qualifications
Bachelor's degree.
3 - 5 years of experience within Medicaid claims and encounter operations.
3 - 5 years managing large-scale projects and cross-functional teams.
Deep expertise with health plan EDI transactions, X12 (835, 837, 834, etc.)
Success in developing working relationships within a highly matrixed business environment.
Ability to analyze data and make informed recommendations.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured.
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to: Provide proof of full vaccination OR
Commit to weekly testing, following all CDC protocols, OR
Provide documentation for a medical or religious exemption consideration. This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.
Preferred Qualifications
Master's Degree.
Experience responding to state and/or federal government solicitations.
Experience developing relationships with key stakeholders to understand and improve the market.
Additional Information
Travel:
5 - 10% to Louisville, KY or Tampa, FL
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40

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