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 and be 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.
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 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 sessions.
- Respond to assigned provider questions or inquiries, and if necessary, ensure prompt resolution to provider issues with appropriate enterprise business teams.
- Convene Service Operating Committee meetings with providers, including organizing agendas, materials, and other team members.
- 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, such as claims, reimbursement, and provider enrollment.
- Ensure compliance with Indiana's managed care contractual requirements for provider relations.
Required Qualifications:
- Must reside in Indiana.
- Requires frequent travel to providers and Humana locations - up to 25%.
- 2+ years of healthcare 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.
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: minimum download speed of 25 Mbps and upload speed of 10 Mbps, wireless, wired cable, or DSL connection.
- Occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours:
- 40
Pay Range:
- $59,300 - $80,900 per year
Description of Benefits:
- Humana offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance, and many other opportunities.