Humana Looking For Senior Provider Connectivity Professional – Remote USA at Louisville, KY Full Time

The Senior Provider Connectivity Professional provides analysis and support to both internal and external customers on complex EDI-related issues for our Medicaid line of business. This includes collaborating cross functionally to identify process opportunities to improve the provider experience. This includes responsibility for evaluating the processes through the eyes of customers, members and provider partners in order to make improvements in cost, quality and speed to market. This will include performing analysis related to solution design, development, testing, maintenance, and support for electronic data interchange (EDI) interfaces and systems, both to and from trading partners and core business systems for our Medicaid product line.

Responsibilities

The Senior Provider Connectivity Professional will analyze and respond to inquiries regarding initial EDI set ups and issues related to EDI enrollments and clearinghouse activities for HIPAA EDI transaction sets (electronic authorizations, electronic attachments, and eligibility and benefits). You will assist with operational strategic objectives by analyzing business processes and functions, ensuring compliance with CAQH CORE Operating Rules, HIPAA and X12 standards and guidelines, gather data, and evaluate input and output requirements and formats to formulate and implement recommended solutions. You will prepare reports and diagrams and maintain companion guides and other supporting documentation by collecting, analyzing, and summarizing information and trends. Responsibilities will include: project planning, creating requirements, facilitating, writing test cases conduct testing and validate testing results for EDI transactions.

Required Qualifications

• Bachelor’s degree
• Progressive Quality, Process Improvement or Reengineering experience
• Strong Project Management skills
• Strong computer skills including MS Office applications (Word, Excel, PowerPoint, Visio, Project)
• Demonstrated competency in both oral and written communication skills
• Solid understanding of process / work flow concepts
• Excellent interpersonal and teamwork skills

Preferred Qualifications

• Knowledge of EDI transactions in one or more of the following X12 transactions: 270/271, 276/277 835, 837 P/I, 275, 278
• Six Sigma, LEAN, PMP or PMCS certification desired
• SQL knowledge
• CAS/MTV experience
• CGX experience

Additional Information

Remote/Work at Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40