Provider Engagement Pro 2 - Remote Medicaid Relations

Humana; Oklahoma; Hybrid; USD 59,000 - 81,000; Full time

Benefits offered by this job

Hybrid work model

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana is seeking a Provider Engagement Professional 2 in Oklahoma to develop and grow positive, long-term relationships with physicians, providers and health systems to support and improve performance within the Oklahoma Medicaid plan.

The role entails frontline provider relations, onboarding, trainings, answering inquiries, and collaborating with claims, enrollment and reimbursement teams to ensure a high-quality, compliant provider experience across Humana’s Healthy Horizons network in

Qualifications

• 2+ years of health care or managed care experience working with providers.
• Knowledge of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Must reside in Oklahoma and be able to travel up to 50% daily.

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.
• Conduct trainings and education for assigned providers, including required annual trainings.
• Support onboarding for new assigned providers with orientation sessions.
• Respond to provider questions or inquiries, and ensure prompt resolution with enterprise business teams (claims payment, prior authorizations, referrals) and provider participation education.
• Convene Service Operating Committee meetings with providers to discuss operational, clinical, and quality topics.
• Communicate updates on Humana policies and Oklahoma’s SoonerSelect programmatic updates.
• Coordinate regional provider townhalls and trainings.
• Work with internal resources and systems (claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Oklahoma Medicaid plan.
• Ensure compliance with Oklahoma’s managed care contractual requirements for provider relations, including timely claims dispute resolution.

Skills

Provider relations

Claims education

Interpersonal skills

Travel readiness

Education

Bachelor’s Degree

Job description

Humana is seeking a Provider Engagement Professional 2 in Oklahoma to develop and grow positive, long-term relationships with physicians, providers and health systems to support and improve performance within the Oklahoma Medicaid plan.

The role entails frontline provider relations, onboarding, trainings, answering inquiries, and collaborating with claims, enrollment and reimbursement teams to ensure a high-quality, compliant provider experience across Humana’s Healthy Horizons network in