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Job Information
Job title

EDI Manager -- Provider Connectivity Services

Company Humana
Wage between $0.00 - $0.00 Annually
Location United States, Kentucky, Louisville
Employment type Full Time
Education Not Specified
Year Experience 4 - 5 Years of Practical Experience
Travel About 50%
Published on 7/11/2008
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.

As a PNO Manager in the PCS team, the successful candidate will direct a team of Process Consultants responsible for the following:
  • Corporation-wide claim and encounter acquisition, validation and routing
  • EDI Trading Partner management
  • Electronic Remit Advice provider set up, tracking and support
  • eHub Business owner (HIPAA Transaction processing)
  • EDI issues management and resolution
  • provider portal support and internal communications
    The candidate should be a self-motivated professional with prior management experience in electronic data interchange (EDI), HIPAA transaction processing and process improvement methodologies. The candidate will provide leadership for the team and ensure support for corporate strategic initiatives and Integrated Provider Solution goals / objectives. The candidate must be a proactive communicator with proven multi-task management ability.

    Daily Tasks:
  • Verify the uninterrupted receipt and routing of claims / encounters from all sources
  • Provide oversight and direction to the issues management team and ensure timely and appropriate response to assigned issues.
  • Develop and implement plans for staffing, personnel development and cross-training initiatives.
  • Interact with a wide variety of management personnel, both internal and external, to ensure coordination of work effort, adherence to service level commitments and budgetary compliance.
  • Identify and implement changes to reduce EDI expenses
  • Organize and conduct inter- and intra-departmental team meetings to identify opportunities for process improvements; implement and/or facilitate initiatives to improve Humana PNO and related processes.
  • Analyze internal and external departmental metrics to identify trends, patterns and problems; proactively pursue resolution of immediate issues and implementation of long term improvements

    Role Essentials:
  • Strong background in healthcare and/or health insurance
  • Bachelors degree
  • Strong knowledge of EDI transactions and HIPAA processes
  • Technical background in EDI
  • Management experience and abilitiesdf-tc

    Experience/Skills
    See Above

    Other desired skills:
    PNO Manager -- Provider Connectivity Services
    •