[Hiring] Provider Engagement Professional @Humana

Role Description

The Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan. You will report to the Provider Engagement Manager.

The Provider Engagement Professional is responsible for day-to-day front line relationship management for network providers in Humana's Healthy Horizons in Indiana's Medicaid Plan, including:

• Provider onboarding
• Training and education
• Responding to provider inquiries
• Resolving issues or complaints

You will support physical and behavioral health providers in your designated region and must be based in Indiana.

Key Role Objectives

• Serve as primary relationship manager with physical and behavioral health providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention.
• Meet regularly, both in person and virtually, with assigned providers to conduct trainings and education, including required annual trainings, ensure understanding of Humana policies and procedures, explain Humana systems, etc.
• Support new assigned providers with onboarding, including orientation session(s).
• Respond to assigned provider questions or inquiries, and if necessary, ensure prompt resolution to provider issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals.
• Convene Service Operating Committee meetings with providers, including organizing agendas, materials, and other team members (clinical, provider engagement).
• Communicate updates on Humana's policies and procedures and Indiana's programmatic updates.
• Coordinate regional provider townhalls and/or trainings.
• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment).
• Ensure compliance with Indiana's managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes.

Qualifications

• Must reside in Indiana
• Requires frequent travel to providers and Humana locations - up to 25%
• 2+ years of health care or managed care experience working with physical health and behavioral health providers
• Experience with training and educating providers
• Experience with formal presentations using PowerPoint
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution
• Knowledge of Microsoft Office applications such as Excel (pivot tables, macros, etc.)

Requirements

• Bachelor's Degree (Preferred)
• Experience with Indiana Medicaid (Preferred)
• Experience working with behavioral health providers, facilities and/or FQHCs (Preferred)
• Understanding of managed care contracts, including contract language and reimbursement (Preferred)

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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.