Provider Engagement Professional

Indiana, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Managed CareIndustries

Requirements

Candidates must possess a Bachelor's degree or equivalent experience, with 1-5 years of experience in healthcare or managed care, specifically in provider contracting, network management, or provider relations. A proven understanding of the Indiana Medicaid program operations, reimbursement methodologies, and bonus structures is required, along with demonstrated ability to manage multiple projects and meet deadlines. Candidates must be passionate about improving consumer experiences and reside in Indiana.

Responsibilities

The Provider Engagement Professional develops and maintains positive, long-term relationships with physicians, providers, and healthcare systems to enhance financial and quality performance. This role involves representing the health plan's provider relationships across various areas including financial performance, incentive programs, quality management, population health, data sharing, and operational improvements. The professional also supports HEDIS and STARs performance, member and provider experience, market growth, and operational excellence.

Skills

Provider Contracting

Network Management

Provider Relations

Indiana Medicaid

Reimbursement Methodologies

Bonus Methodologies

Project Management

Deadline Management

Consumer Experience Improvement

Data Analysis

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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