Provider Engagement - Behavioral Health at Humana

Oklahoma City, Oklahoma, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Medicaid, Behavioral HealthIndustries

Requirements

Must reside in Oklahoma
Position is field-based in Oklahoma and requires frequent travel to providers in Oklahoma County and Humana locations
2 or more years of health care or managed care experience working with providers (e.g., provider relations, claims education)
Experience working with or in health care administration setting
Exceptional relationship management and interpersonal skills
Proficiency in analyzing, understanding, and communicating complex issues
Exceptional time management and ability to manage multiple priorities in a fast-paced environment
Knowledge of Microsoft Office applications
Valid state driver's license and maintenance of personal vehicle liability insurance (part of Humana's driver safety program)
Preferred Qualifications
Bachelor’s Degree
Experience with Oklahoma Medicaid
Experience working with behavioral health providers, facilities and/or FQHCs
Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution
Understanding of managed care contracts, including contract language and reimbursement

Responsibilities

Serve as primary relationship manager with 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, as well as appropriate education about participation in Humana’s Oklahoma Medicaid plan
Convene Joint Operating Committee meetings with providers, including organizing agendas, materials, and other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics
Communicate updates on Humana’s policies and procedures and Oklahoma’s SoonerSelect programmatic updates
Coordinate regional provider townhalls and/or trainings
Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Oklahoma Medicaid plan
Ensure compliance with Oklahoma’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes

Skills

Provider Relations

Relationship Management

Provider Onboarding

Healthcare Training

Issue Resolution

Claims Processing

Prior Authorizations

Medicaid Operations

Critical Thinking

Interpersonal Communication

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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