Oklahoma Provider Engagement Pro II (Remote/Hybrid)

Humana; United States; Hybrid; USD 59,000 - 81,000; Full time

Job summary

Humana in Oklahoma’s Healthy Horizons Medicaid program seeks a Provider Engagement Professional 2 to build and maintain strong relationships with physicians, providers, and health systems in the region. You will manage onboarding, training, education, and inquiries, resolve issues, and ensure compliance with Oklahoma Medicaid requirements, while traveling up to 50% in a hybrid remote/office role.

This position emphasizes critical thinking, health plan operations knowledge, and excellent

Qualifications

• 2+ years of health care or managed care experience working with providers.
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Must reside in Oklahoma.
• Willing and able to travel frequently to providers and Humana locations (daily travel up to 50% of the time).

Responsibilities

• Serve as primary relationship manager with physical and behavioral health providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention.
• Meet regularly, both in person and virtually, with assigned providers to conduct trainings and education, including required annual trainings, ensure understanding of Humana policies and procedures, explain Humana systems, etc.
• Support new assigned providers with onboarding, including orientation session(s).
• Respond to assigned provider questions or inquiries, and if necessary, ensure prompt resolution to provider issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana's Oklahoma Medicaid plan.
• Convene Service Operating Committee meetings with providers, including organizing agendas, materials, and other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics.

Skills

Provider relations

Healthcare experience

Travel readiness

Oklahoma residency

Education

Bachelor's Degree

Job description

Humana in Oklahoma’s Healthy Horizons Medicaid program seeks a Provider Engagement Professional 2 to build and maintain strong relationships with physicians, providers, and health systems in the region. You will manage onboarding, training, education, and inquiries, resolve issues, and ensure compliance with Oklahoma Medicaid requirements, while traveling up to 50% in a hybrid remote/office role.

This position emphasizes critical thinking, health plan operations knowledge, and excellent