Provider Engagement Professional at Humana

Job description

Become a part of our caring community The Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order 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, education, responding to provider inquiries, and resolving issues or complaints. You will support physical and behavioral health providers in their 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 inquires, 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 Use your skills to make an impact Required 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.) Preferred Qualifications Bachelor's Degree Experience with Indiana Medicaid Experience working with behavioral health providers, facilities and/or FQHCs Understanding of managed care contracts, including contract language and reimbursement Additional Information Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. 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 re