Senior Provider Engagement Professional

Role Overview

• Foster positive provider experience for assigned providers in Humana Michigan Medicaid Program.
• Manage onboarding and orientations for new providers to Humana’s network.
• Conduct ongoing education and training to support Humana Michigan Medicaid Program network providers in self-service functions - such as eligibility confirmation, claims submission and payment - by use of available tools.
• Schedule, prepare and facilitate Joint Operating Committee or other provider meetings, at times in partnership with other market and/or enterprise teams.
• Ensure prompt resolution of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, referrals and state or Commissioner of Insurance inquiries.
• Create and/or deliver trainings and educational materials for Humana Michigan Medicaid providers on Humana processes and procedures and location of all content on website.
• Participate and/or speak at Town Halls, webinars, or other forums to communicate important policy or programmatic updates to providers.
• Ensure compliance with Michigan managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes.
• Schedule, prepare and complete on-site provider location visits to nurture relationships; attend association conferences, as necessary.
• Obtain and relay accurate required credentialing documents to credentialing team from the provider.

Required Qualifications

• 3+ years of health care or managed care experience working with providers (e.g., provider relations, claims education).
• Experience with Michigan Medicaid
• Knowledge of Microsoft Office applications.
• Demonstrated ability to manage multiple projects and meet deadlines.
• Exceptional relationship management skills.
• Experience handling escalated or highly visible provider complaints/issues to resolution.
• Understanding of health insurance claims and ability to analyze data to resolve provider service issues.
• Excellent written and verbal communication skills.
• Proficiency in analyzing, understanding, and communicating complex issues.
• Exceptional time management and ability to manage multiple priorities in a fast-paced environment.
• The applicant must be located in or willing to relocate to the Metro Detroit area.

Preferred Qualifications

• Bachelor’s Degree.
• Experience working for or with key provider types (primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers).
• Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Experience with service coordination, prior authorizations, and other health plan processes.

Travel

• 3-5 days a week – Metro Detroit Area
• Must have a Valid driver’s license with reliable transportation and the ability to travel within the state, as required.
• This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.