Provider Relations Representative
Humana
Become a part of our caring community and help us put health first
The Provider Relations Representative (Provider Engagement Professional 2) is responsible for day-to-day front line relationship management of network providers in Humana’s Healthy Horizons in Virginia Medicaid network. This role supports provider onboarding, training, education, and inquiry/issue support resolution. This role specifically supports long-term services and supports (LTSS) and home and community-based services (HCBS) providers and must be based in Virginia. The individual in this role should have critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.Serve as primary relationship manager with assigned LTSS and HCBS providers to ensure positive provider experience with Humana Healthy Horizons and promote network retentionMeet regularly, both in person and virtually, with assigned providers to conduct training and education, including, but not limited to, required annual trainings, periodic updates to and/or reviews of Humana policies and procedures, and Humana systems training and updates Support newly assigned providers with onboarding, including hosting orientation session(s) Respond to assigned provider inquiries and support prompt issue resolution, including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals) Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide Exceptional Experience in all provider interactionsCreate provider trainings based on provider feedback, trends in claims or process changesEducate provider on location and content of all provider facing materials (Orientation, Provider Manual, Newsletter, Program Updates, Etc.)Convene regular meetings with providers, including organizing agendas, materials, meeting minutes, other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topicsEducate on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, Quality resources, and member resourcesCommunicate updates on Humana’s policies and procedures and Cardinal Care programmatic updatesCoordinate regional provider townhalls and/or trainingsAttend Network Meetings/ConferencesEnsure compliance with all Virginia managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc.
Use your skills to make an impact
Required Qualifications 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education)Experience working with LTSS and/or HCBS provider operations, building strong relationships with provider organizations, financial/contracting arrangements, and/or regulatory requirementsExceptional relationship management and interpersonal skillsProficiency in analyzing, understanding, resolving, and communicating complex issuesExceptional time management and ability to manage multiple priorities in a fast-paced environmentThorough understanding of managed care contracts, including contract language and reimbursementExceptional written and verbal communication skillsStrong presentation and facilitation skillsKnowledge of Microsoft Office applicationsPosition is field based in Virginia and requires frequent travels to provider and Humana locationsPreferred QualificationsBachelor’s DegreeExperience with Virginia MedicaidUnderstanding of claims systems, adjudication, submission processes, coding, and/or dispute resolutionUnderstanding of service coordination, prior authorizations, and other health plan processesUnderstanding of value-based payment programs
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.
The Provider Relations Representative (Provider Engagement Professional 2) is responsible for day-to-day front line relationship management of network providers in Humana’s Healthy Horizons in Virginia Medicaid network. This role supports provider onboarding, training, education, and inquiry/issue support resolution. This role specifically supports long-term services and supports (LTSS) and home and community-based services (HCBS) providers and must be based in Virginia. The individual in this role should have critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.Serve as primary relationship manager with assigned LTSS and HCBS providers to ensure positive provider experience with Humana Healthy Horizons and promote network retentionMeet regularly, both in person and virtually, with assigned providers to conduct training and education, including, but not limited to, required annual trainings, periodic updates to and/or reviews of Humana policies and procedures, and Humana systems training and updates Support newly assigned providers with onboarding, including hosting orientation session(s) Respond to assigned provider inquiries and support prompt issue resolution, including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals) Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide Exceptional Experience in all provider interactionsCreate provider trainings based on provider feedback, trends in claims or process changesEducate provider on location and content of all provider facing materials (Orientation, Provider Manual, Newsletter, Program Updates, Etc.)Convene regular meetings with providers, including organizing agendas, materials, meeting minutes, other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topicsEducate on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, Quality resources, and member resourcesCommunicate updates on Humana’s policies and procedures and Cardinal Care programmatic updatesCoordinate regional provider townhalls and/or trainingsAttend Network Meetings/ConferencesEnsure compliance with all Virginia managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc.
Use your skills to make an impact
Required Qualifications 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education)Experience working with LTSS and/or HCBS provider operations, building strong relationships with provider organizations, financial/contracting arrangements, and/or regulatory requirementsExceptional relationship management and interpersonal skillsProficiency in analyzing, understanding, resolving, and communicating complex issuesExceptional time management and ability to manage multiple priorities in a fast-paced environmentThorough understanding of managed care contracts, including contract language and reimbursementExceptional written and verbal communication skillsStrong presentation and facilitation skillsKnowledge of Microsoft Office applicationsPosition is field based in Virginia and requires frequent travels to provider and Humana locationsPreferred QualificationsBachelor’s DegreeExperience with Virginia MedicaidUnderstanding of claims systems, adjudication, submission processes, coding, and/or dispute resolutionUnderstanding of service coordination, prior authorizations, and other health plan processesUnderstanding of value-based payment programs
Additional Information
Position must be in one of six regions within Virginia (Tidewater, Central/Richmond, Western/Charlottesville, Northern/Winchester, Roanoke/Alleghany, Southwest)Scheduled Weekly Hours
40Pay 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.
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
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
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