[Remote] Provider Engagement Professional 2 LTSS at Humana

Illinois, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Must live in the State of Illinois (East St Louis area preferred) and be able to travel throughout Illinois as needed for role
2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education)
Experience working with physical health providers, facilities, ancillary providers, and/or FQHCs
Experience working with Illinois Medicaid
Experience in provider operations, building strong relationships with provider organizations, financial/contracting arrangements, and/or regulatory requirements
Exceptional relationship management and interpersonal skills
Proficiency in analyzing, understanding, resolving, and communicating complex issues
Exceptional time management and ability to manage multiple priorities in a fast-paced environment
Thorough understanding of managed care contracts, including contract language and reimbursement
Exceptional written and verbal communication skills, along with strong presentation and facilitation skills
Intermediate to advanced knowledge of Microsoft Office Suite applications, specifically Word, Excel, and PowerPoint
Valid state driver's license (as part of Humana’s Driver Safety program)

Responsibilities

Serve as primary relationship manager with assigned providers to ensure positive provider experience with Humana’s Dual Fully Integrated plan of Illinois and promote network retention
Meet regularly, both in-person and virtually, with assigned providers to conduct training and education, including 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 collaboration with appropriate enterprise business teams (e.g., claims payment, prior authorizations & referrals)
Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide Exceptional Experience in all provider interactions
Create provider trainings based on provider feedback, trends in claims or process changes
Educate providers 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 topics
Educate on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, Quality resources, and member resources
Communicate updates on Humana’s policies and procedures and Cardinal Care programmatic updates
Coordinate periodic regional provider townhalls and/or trainings
Attend Network Meetings/Conferences
Ensure compliance with all Virginia managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc

Skills

provider relationship management

provider onboarding

health plan operations

critical thinking

problem solving

interpersonal skills

training development

issue resolution

claims processing

prior authorizations

provider enrollment

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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