Provider Engagement Professional

Illinois, 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

Health Insurance, HealthcareIndustries

Requirements

Candidates must reside in Illinois and be able to travel within the state, possessing at least 2 years of healthcare or managed care experience working with providers. Experience with physical health providers, facilities, ancillary providers, and/or FQHCs, along with familiarity with Illinois Medicaid and provider operations, is required. Strong relationship management, interpersonal, analytical, time management, and communication skills are essential, as is intermediate to advanced proficiency in Microsoft Office Suite. A valid driver's license is also necessary.

Responsibilities

The Provider Engagement Professional will manage relationships with network providers, supporting onboarding, training, education, and issue resolution. They will conduct regular meetings with providers to discuss operational, clinical, and quality topics, and educate them on Humana policies, procedures, and systems. Responsibilities include responding to provider inquiries, collaborating with internal teams to resolve issues, creating provider trainings, and ensuring compliance with managed care contractual requirements.

Skills

Provider Engagement

Relationship Management

Onboarding

Training

Education

Issue Resolution

Critical Thinking

Problem Solving

Health Plan Operations

Interpersonal Skills

Claims Processing

Reimbursement

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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