Indiana Provider Relations Specialist (Medicaid)

Humana; Indiana; Remote; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Provider Engagement Professional in Indiana to build and maintain positive relationships with physicians, providers and healthcare systems within Humana Healthy Horizons. You will manage day-to-day provider relations, onboard new providers, coordinate trainings, and respond to inquiries, while collaborating with internal teams to resolve issues and ensure contractual compliance.

The role supports both physical and behavioral health providers, requires up-to-date knowledge of

Qualifications

• Must reside in Indiana.
• Requires travel to providers and Humana locations—up to 25%.
• 2+ years of health care or managed care experience working with physical and behavioral health providers.
• Experience with training and educating providers.
• Experience with formal presentations using PowerPoint.
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Knowledge of Microsoft Office applications such as Excel (pivot tables, macros, etc.).

Responsibilities

• Serve as primary relationship manager with physical and behavioral health providers to ensure positive provider experience and promote network retention.
• Conduct trainings and education with assigned providers, including required annual trainings.
• Assist onboarding of new providers with orientation sessions.
• Respond to provider inquiries and coordinate prompt resolution with enterprise teams (claims, prior authorizations, referrals).
• Convene Service Operating Committee meetings with providers and internal teams.
• Communicate updates on Humana policies and Indiana programmatic updates.
• Coordinate regional provider townhalls and trainings.
• Collaborate with internal resources and systems (claims, reimbursement, provider enrollment).
• Ensure compliance with Indiana managed care contractual requirements for provider relations and claims disputes timelines.

Skills

Provider relations

Healthcare experience

Training delivery

PowerPoint

Claims systems knowledge

Excel (Pivot tables)

Education

Bachelor's Degree

Tools

PowerPoint

Excel

Job description

Humana is seeking a Provider Engagement Professional in Indiana to build and maintain positive relationships with physicians, providers and healthcare systems within Humana Healthy Horizons. You will manage day-to-day provider relations, onboard new providers, coordinate trainings, and respond to inquiries, while collaborating with internal teams to resolve issues and ensure contractual compliance.

The role supports both physical and behavioral health providers, requires up-to-date knowledge of