Provider Engagement Professional

About the Role

Employment Type: Full time

Become a part of our caring community and help us put health first. Humana Gold Plus Integrated is seeking Provider Engagement Professionals (Physician and LTSS) who are responsible for day-to-day, front-line relationship management for network providers in Humana. This role supports provider onboarding, training, education, and inquiry/issue support and resolution. The individuals in this role should have critical thinking/problem solving skills, an understanding of health plan operations, and strong interpersonal skills. The Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems.

Responsibilities

The Provider Engagement Professional (Physician and LTSS) roles and responsibilities include:

• 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, 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 (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 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 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.

Use your skills to make an impact.

Required Qualifications

• Must live in the State of Illinois 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.
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver's license.