35 Administration jobs in Hilliard
Manager, Medicare Administration
Posted 1 day ago
Job Viewed
Job Description
**Job Summary**
Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services.
**Knowledge/Skills/Abilities**
- Establishes audit controls and measurements to ensure correct processes are established. Develops and performs internal audits/risk assessments, monitoring program for Molina Healthcare departments. Provides post audit findings and recommendations to ensure contractual State and Federal Compliance.
- Coordinates development of written policies and procedures regarding compliance with local, state and federal guidelines.
- Establishes member grievance appeals and policies and updates annually or as directed by the Centers for Medicare and Medicaid Services.
- Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the Center for Medicare and Medicaid.
- Responsible for development, implementation and maintenance of department strategic initiatives.
**Job Qualifications**
**Required Education**
Bachelors Degree
**Required Experience**
5-7 Years
**Preferred Education**
Graduate Degree or equivalent combination of education and experience
**Preferred Experience**
7-9 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Financial Administration Senior Analyst
Posted 12 days ago
Job Viewed
Job Description
Our client, a leading global financial services company, has approximately 200 million customer accounts and does business in more than 140 countries. They provide consumers, corporations, governments, and institutions with financial products and services, including consumer banking and credit, corporate and investment banking, securities brokerage, transaction services, and wealth management.
Financial AdministrationJob Summary
The Financial Administration Senior Analyst, Assistant Vice-President level oversees the preparation of monthly, semi-annual, and annual reports for investment companies in accordance with U.S. Generally Accepted Accounting Principles (GAAP) and Securities and Exchange Commission (SEC) requirements. The AVP collaborates with other members of Financial Administration to support the analysis, monitoring, and implementation of monthly and annual excise distribution processes, along with other reporting such as Total Returns, Board reporting, and year-end tax reporting requirements.
Key Responsibilities- Act as the primary contact for clients and respond proactively to internal and external client inquiries.
- Manage the preparation of financial statements and review SEC filings (e.g., N-PORT, N-MFP, N-CSR, N-CEN, 24F-2, N-1A, etc.).
- Serve as the primary contact for the annual audit process.
- Oversee monthly and quarterly client reporting (e.g., Total Returns and preparation of Board reports).
- Demonstrate an advanced understanding of investment types, mutual funds, ETFs, and financial markets.
- Lead training sessions to increase the team's knowledge.
- Identify and implement process improvements to reduce risk and improve efficiency.
- Manage client projects and initiatives.
- Participate in department committees and other initiatives.
Qualifications
Job Specifications:
Bachelor's Degree in Accounting, Finance, or a business-related area or equivalent work experience.
5-7 years of relevant experience.
Telephonic UM Administration Coordinator
Posted today
Job Viewed
Job Description
The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.
UM Administration Coordinator 2
+ Primarily receive calls from Providers, Hospitals, Skilled Nursing Facilities and other vendors
+ Support the UM Nurses to process discharge orders and arrange a safe facility discharge.
+ Work with UM Nurses, Pharmacy, Medical Directors and other Departments.
+ During downtime make calls to UM Nurses, Hospitals, Skilled Nursing Facilities and other vendors.
+ Document all calls and requests.
+ Search for Medicare and Medicaid Guidelines.
+ Process all incoming fax/emails request for services the same day.
+ Return call for all voice messages received the same day.
+ Process provider and member letters (Letter of Agreements, Approvals, Denials etc.)
+ Mail letters to members.
+ Assist the team with various clerical/administrative tasks as necessary.
+ Participate in special projects as assigned by your Supervisor or Manager.
**Use your skills to make an impact**
Additional Job Description
**Required Qualifications**
+ 1 or more years of Administrative support experience
+ 1 or more years of Healthcare experience
+ 1 or more years of telephonic Customer Service experience
+ Working knowledge of Microsoft Word, Excel, and Outlook.
+ Monday-Friday 8am-5pm EST, must have ability to work Nights, Weekends and Holidays based on business needs.
**Preferred Qualifications**
+ Bilingual English/Spanish able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing
+ Proficient utilizing documentation programs.
+ Experience with the CarePlus Platform.
+ Proficient and/or experience with medical terminology and/or ICD-10 codes.
+ Member service
+ Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization.
**Additional Information**
**Work Schedule:**
+ Monday-Friday 8am-5pm EST, and work 1 weekend a quarter. Schedule subject to change based on business needs.
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, 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.
**Work at Home Guidance**
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
+ Satellite, cellular and microwave connection can be used only if approved by leadership
+ Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
#LI-BB1
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$40,000 - $52,300 per year
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.
About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our
Consultant, Sales Compensation Administration
Posted 3 days ago
Job Viewed
Job Description
What Rewards Architecture contributes to Cardinal Health
Rewards Architecture is responsible for designing, developing and administering sales compensation and reward/recognition architecture that attracts, retains and motivates sales teams to drive superior performance and results that align with business strategies.
The Consultant, Sales Compensation Administrator is responsible for the monthly and quarterly administration of our sales compensation plans. They will also be responsible for maintaining all the commission administration data that is used for ad hoc reporting and quarterly reporting for senior leadership, as well as building modeling to articulate impacts on sales compensation and design decisions. They also serve as the point of contact for all our sales teams if they have questions about sales incentives.
What is expected of you for success in your role
-
Demonstrates advanced knowledge of how to interpret and apply current market trends to establish and implement an effective sales reward structure
-
Works independently and generates conclusions around data to drive process improvements and system improvements and to increase accuracy, efficiency and effectiveness in support of sales rewards architecture
-
Creates advanced compensation and performance analytics and reporting by synthesizing information from multiple sources for varied constituents
-
Facilitates/manages processes in a moderately complex matrix environment
-
Proactively provides internal customers with quality experiences through effective communication; listens to customers' needs and takes actions to meet them
Responsibilities
-
Assists in annual sales compensation plan design process
-
Builds financial templates and models to calculate sales compensation payouts and varied performance scenarios to show the financial impact of decisions
-
Assists/leads annual planning and maintenance of sales quotas
-
Translates compensation plan designs into detailed reporting requirements
-
Assembles sales-facing communications - effectively detailing plan designs, support processes and tools
-
Pulls and analyzes data from various sources to calculate sales compensation payouts on a monthly and quarterly basis
-
Supports process for measuring sales compensation plan effectiveness
-
Creates and maintains SOP for sales compensation calculation and administration
-
Assists in the management of a robust compensation governance model
-
Collaborates with SMEs to ensure best practices and controls are regularly reviewed, implemented and followed
Competencies
-
Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects
-
May contribute to the development of policies and procedures
-
Works on complex projects of large scope
-
Develops technical solutions to a wide range of difficult problems. Solutions are innovative and consistent with organization objectives
-
Completes work independently; receives general guidance on new projects
-
Work reviewed for purpose of meeting objectives
-
May act as a mentor to less experienced colleagues
Qualifications
-
Bachelor's degree in related field preferred, or equivalent work experience preferred
-
5 years of general business experience preferred
-
Sales compensation administration experience preferred
-
Finance background a plus
-
Advanced Excel skills
-
Strong communication skills
-
Customer service, problem solving and analytical skills required
-
Must have the ability to interpret data and ask questions regarding outliers
-
Strong curiosity in the "why" of the data that is presented
-
Critical thinking skills
Anticipated salary range: $66,500 - $99,645
Bonus eligible: No
Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
-
Medical, dental and vision coverage
-
Paid time off plan
-
Health savings account (HSA)
-
401k savings plan
-
Access to wages before pay day with myFlexPay
-
Flexible spending accounts (FSAs)
-
Short- and long-term disability coverage
-
Work-Life resources
-
Paid parental leave
-
Healthy lifestyle programs
Application window anticipated to close: 10/11/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.
To read and review this privacy notice click here (
Consultant, Sales Compensation Administration
Posted 11 days ago
Job Viewed
Job Description
Rewards Architecture is responsible for designing, developing and administering sales compensation and reward/recognition architecture that attracts, retains and motivates sales teams to drive superior performance and results that align with business strategies.
The Consultant, Sales Compensation Administrator is responsible for the monthly and quarterly administration of our sales compensation plans. They will also be responsible for maintaining all the commission administration data that is used for ad hoc reporting and quarterly reporting for senior leadership, as well as building modeling to articulate impacts on sales compensation and design decisions. They also serve as the point of contact for all our sales teams if they have questions about sales incentives.
**_What is expected of you for success in your role_**
+ Demonstrates advanced knowledge of how to interpret and apply current market trends to establish and implement an effective sales reward structure
+ Works independently and generates conclusions around data to drive process improvements and system improvements and to increase accuracy, efficiency and effectiveness in support of sales rewards architecture
+ Creates advanced compensation and performance analytics and reporting by synthesizing information from multiple sources for varied constituents
+ Facilitates/manages processes in a moderately complex matrix environment
+ Proactively provides internal customers with quality experiences through effective communication; listens to customers' needs and takes actions to meet them
**_Responsibilities_**
+ Assists in annual sales compensation plan design process
+ Builds financial templates and models to calculate sales compensation payouts and varied performance scenarios to show the financial impact of decisions
+ Assists/leads annual planning and maintenance of sales quotas
+ Translates compensation plan designs into detailed reporting requirements
+ Assembles sales-facing communications - effectively detailing plan designs, support processes and tools
+ Pulls and analyzes data from various sources to calculate sales compensation payouts on a monthly and quarterly basis
+ Supports process for measuring sales compensation plan effectiveness
+ Creates and maintains SOP for sales compensation calculation and administration
+ Assists in the management of a robust compensation governance model
+ Collaborates with SMEs to ensure best practices and controls are regularly reviewed, implemented and followed
**_Competencies_**
+ Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects
+ May contribute to the development of policies and procedures
+ Works on complex projects of large scope
+ Develops technical solutions to a wide range of difficult problems. Solutions are innovative and consistent with organization objectives
+ Completes work independently; receives general guidance on new projects
+ Work reviewed for purpose of meeting objectives
+ May act as a mentor to less experienced colleagues
**_Qualifications_**
+ Bachelor's degree in related field preferred, or equivalent work experience preferred
+ 5 years of general business experience preferred
+ Sales compensation administration experience preferred
+ Finance background a plus
+ Advanced Excel skills
+ Strong communication skills
+ Customer service, problem solving and analytical skills required
+ Must have the ability to interpret data and ask questions regarding outliers
+ Strong curiosity in the "why" of the data that is presented
+ Critical thinking skills
**Anticipated salary range:** $66,500 - $99,645
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 10/11/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (
Manager, Provider Network Administration (Remote)
Posted 2 days ago
Job Viewed
Job Description
Job Description
Job Summary
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
Knowledge/Skills/Abilities
-
Manages all aspects of the Provider Administration area and serves as contact point for all configuration issues to ensure processes are carried out timely and accurately.
-
Establishes, maintains and analyzes internal standard operating policies and procedures pertaining to department functions.
-
Produces reports related to provider network information.
-
Collaborates with local and corporate departments on issues related to provider loads including, but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.
-
Identifies issues, resolves problems and implements best practices.
Job Qualifications
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
-
5-7 years managed care experience, including min. 2 years of supervisory experience
-
Min. 2 years health plan Provider Network experience
Required License, Certification, Association
N/A
Preferred Education
Bachelor's Degree
Preferred Experience
-
7+ years managed care experience
-
QNXT; SQL experience
-
Crystal Reports for data extraction
-
Access and Excel - intermediate plus skill level
Preferred License, Certification, Association
N/A
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $60,415 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Patient Access Representative - Radiology Administration
Posted 14 days ago
Job Viewed
Job Description
Schedule: Rotating call, weekends and holidays.
Shifts: 7:30 AM to 4:00 PM and 8:30 AM to 5:00 PM
The Patient Access Representative is responsible for greeting and registering patients, answering telephone calls, scheduling appointments, and pulling and filing medical charts when indicated.
Essential Functions:
- Provides excellent customer service to patients and families by applying best practices and standard operating procedures.
- Interviews and registers patients in registration areas that report up through Patient Access.
- Obtains accurate demographic, insurance, and physician information on registrations.
- Screens customer data to ensure patient is eligible for insurance indicated. Communicates differences to the customer.
- Screens registrations to ensure insurance pre-certification and physician referral requirements are met. Instructs customer on requirements.
- Assists in identifying self-pay patients and referring them to financial assistance when applicable. Instructs customer on requirements.
- Establishes and maintains open communication with all departments that Patient Access interacts with and clinical staff in those areas.
- Assists in the shadowing/precepting of new employees.
Education Requirement:
- High School Diploma or equivalent, required.
- Associate's Degree, preferred.
Licensure Requirement:
(not specified)
Certifications:
CPR certification (based on position and as determined by manager).
Skills:
- Demonstrated computer skills required with the ability to navigate most current technology systems.
- Strong administrative skills.
- Excellent customer service and organizational skills.
Experience:
One year of health care experience, preferred.
Physical Requirements:
OCCASIONALLY: Blood and/or Bodily Fluids, Driving motor vehicles (work required) *additional testing may be required, Lifting / Carrying: 0-10 lbs, Lifting / Carrying: 11-20 lbs, Loud Noises, Pushing / Pulling: 26-40 lbs, Pushing / Pulling: 41-60 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Bend/twist, Patient Equipment
CONTINUOUSLY: Audible speech, Chemicals/Medications, Color vision, Communicable Diseases and/or Pathogens, Computer skills, Decision Making, Depth perception, Flexing/extending of neck, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Pushing / Pulling: 0-25 lbs, Repetitive hand/arm use, Seeing Far/near, Sitting, Standing, Walking
Additional Physical Requirements performed but not listed above: Ability to multi-task within a stressful environment.
The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet
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SAP Business Objects Administration Lead
Posted 21 days ago
Job Viewed
Job Description
• Proficient knowledge of SAP BusinessObjects. Tableau Administration & Looker setup & Administration experience is a plus.
• Installation, migration, configuration, maintenance, technical support and troubleshooting of SAP Business Objects implementation in a shared environment.
• Drive implementation of best industry practices for Business Objects toolsets.
• Contribute to architecture and capacity planning activities.
• Conduct performance tuning and capacity management.
• Implement Server patch management where new patches and service packs needed to apply to fix bugs following the Change Management process.
• Required to monitor/Handle BO services during windows servers' maintenance.
• Regular BO repository Maintenance like Cleaning Orphaned Connection/Universe/Documents.
• Migration of reports/ universes/ users along with security settings from one DEV/QA stage to PROD Environment using Promotion Management tool following the Change Management Process.
• Creating new project setup with security for new applications.
• Design and implement security by creating user groups, granting access to BOE applications to users and adding security restrictions (application level, folder level, and object level) based on user profile and user groups.
• Troubleshooting report issues, system slowness.
• Create Users, Groups and User access levels and provide access to users on request of the Application team.
• Coordinate with SAP Support for priority issues.
• Explore new BI technologies to expand the tools team supports.
Roles & Responsibilities
• Develop requirements and end user documentation for integrations
• Design appropriate solution components
• Coordinate with business process owners/SMEs for support and development activities.
• Interact with operations team
• Leading integrations development work
• Requirements clarification and documentation
• Support end users for access requests
• Create/update Technical specifications.
• Support application Testing activities
• Onsite-Offshore coordination
Generic Managerial Skills, If any
Good Team management skills
Planning and Organizing skills
Excellent Communication (written and verbal) skills
Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.
Utilization Management Administration Coordinator (SNF)
Posted 2 days ago
Job Viewed
Job Description
The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
Job Description
**Achieve your best at Humana. Join Us!** The UM Administration Coordinator provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.
The Home Solutions UM Team is hiring for a UM Administration Coordinator that will provide non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members utilizing Home Health and Skilled Nursing Facility services. This team sits in the Home Solutions organization and contributes to the Value-Based segment partnering with CenterWell and Onehome.
+ Manages NLP's for chart reviews for the nursing team
+ Builds and pends authorizations for review
+ Responsible for inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status throughout the day
+ Documents calls and attaches clinical information received
+ Requests clinical information from providers/facilities
+ Creates and sends out written correspondence
+ Creates and distributes determination letters
+ Collaborates with multiple roles/departments/providers/team members
*** REMINDER: ATTACH A COPY OF YOUR RESUME***
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
+ Medical Benefits
+ Dental Benefits
+ Vision Benefits
+ Health Savings Accounts
+ Flex Spending Accounts
+ Life Insurance
+ 401(k)
+ PTO including 8 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
+ And more
**Use your skills to make an impact**
**Required Qualifications**
+ 1+ years' experience working in an administrative support capacity
+ Prior professional experience of Microsoft Word, Outlook and Excel with the ability to type and enter data accurately
+ Ability to quickly learn new systems (proficient to advanced)
**Preferred Qualifications**
+ Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
+ Proficient utilizing electronic medical record and documentation programs
+ Proficient and/or experience with medical terminology and/or ICD-10 codes
+ Prior member service or customer service telephone experience desired
+ Experience with SNF and/or Home Health
+ Prior experience with CGX, SRO and HCHB
+ Prior experience in a metric driven environment
+ Prior experience in the healthcare industry
**Additional Information**
+ **Remote position with possibility of flexible working hours Monday to Friday between 8am and 8pm EST (8 paid hours per business day)**
+ **Overtime available based upon business needs**
+ **Weekend and/or holiday work possible for this role**
Work at Home/Remote Requirements
**Work-At-Home Requirements**
+ To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
+ Wireless, Wired Cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
+ Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
**Our Hiring Process**
As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
#LI-LM1
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$40,000 - $52,300 per year
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
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Manager, Provider Network Administration (Remote)

Posted 3 days ago
Job Viewed
Job Description
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**Knowledge/Skills/Abilities**
- Manages all aspects of the Provider Administration area and serves as contact point for all configuration issues to ensure processes are carried out timely and accurately.
- Establishes, maintains and analyzes internal standard operating policies and procedures pertaining to department functions.
- Produces reports related to provider network information.
- Collaborates with local and corporate departments on issues related to provider loads including, but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.
- Identifies issues, resolves problems and implements best practices.
**Job Qualifications**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
- 5-7 years managed care experience, including min. 2 years of supervisory experience
- Min. 2 years health plan Provider Network experience
**Required License, Certification, Association**
N/A
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
- 7+ years managed care experience
- QNXT; SQL experience
- Crystal Reports for data extraction
- Access and Excel - intermediate plus skill level
**Preferred License, Certification, Association**
N/A
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $60,415 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.