Senior Data Management amp Contract Load Professional Remote Nationwide

Profile

Description

Humana is looking for a Senior Provider Data Management & Contract Load Professional to join our team working from home anywhere in the US!

Responsibilities

The Senior Provider Data Management & Contract Load Professional is responsible for administering the installation of assigned provider accounts. This role performs Network Build set-up, database loading, and preparation of administrative documents and materials and provide support to provider accounts by responding to inquiries, and resolving issues of concern. Additionally, the Senior Provider Data Management & Contract Load Professional will maintain datasets which have to be evaluated for the necessary elements required for Provider Loads. These datasets come in various forms depending on the vendor.

Key Role Functions Include:

Necessary procedures to load/maintain these rosters


develop transformation processes to get the data from whatever format the file was given into SQL Server
construct procedures to prepare the data for loading into our Contractual and Directory systems
construct procedures to ensure we are utilizing Physicians and Groups already in our systems (or) construct new Physicians and Groups
construct scripts to update the directories
Audit the load as well as the entire roster will be done to ensure everything is set up properly


On-going Monthly requirements


Receive rosters and determine, after comparison with previous roster, what is to be added, changed, or termed as we do not always receive updates, or, we only receive updates and would then construct a 'new' roster based on these updates and the previous roster sent
Load/Update all Adds, Changes, and Terminations


Auditing Requirements


Provide evidence all Ids (Groups and Physicians) are accurate and according to guidelines


Required Qualifications


Bachelor's degree or equivalent related work experience
Intermediate to Advanced skills using SQL Server and Intermediate MS Access/VBA
Comprehensive knowledge of Microsoft Word and Excel
Ability to write routine reports and correspondence
Excellent communication and interpersonal skills with the ability to speak effectively before groups of customers and/or Humana associates
Problem solving abilities
Self-motivated and task oriented
Able to prioritize assignments with little guidance


Work at Home/Remote Requirements


Must ensure designated work area is free from distractions during work hours and virtual meetings
Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required


Preferred Qualifications


Master's Degree
SSIS experience
Python experience
Experience with Provider reimbursements and/or resolving Provider reimbursement issues
Previous provider relations experience
Prior experience in a medical environment dealing with managed care/insurance issues (i.e. benefits, claims, etc.)


Additional Information

This is a remote role anywhere in the US working standard business hours on Eastern Standard Time.

Scheduled Weekly Hours

40

Company info

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