Provider Engagement Professional 2 LTSS

Provider Engagement Professional (LTSS)

Become a part of our caring community and help us put health first. Humana Gold Plus Integrated is seeking Provider Engagement Professionals (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.

The Provider Engagement Professional (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 (ex., 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 Humanas 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 :

Preferred Qualifications :

Work at Home Requirements :

Additional Information :

Interview Format :

As part of our hiring process, we will be using exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and / or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and / or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

Travel : While this is a remote position, occasional travel to Humanas offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range : The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $59,300 - $80,900 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and / or individual performance.

Description of Benefits : Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us : Humana Inc. (NYSE : HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer : It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base