Provider Relations Representative - BH

Humana; Salem (VA); On-site; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Provider Relations Representative to manage relationships with network providers in Virginia's Medicaid program. This role involves onboarding, training, and support for long-term services and home-based care providers. Ideal candidates will possess strong interpersonal skills and a solid understanding of managed care operations, ensuring a positive provider experience and compliance with contractual requirements.

Benefits

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Life insurance

Qualifications

• 2+ years of healthcare or managed care experience working with providers.
• Exceptional relationship management and interpersonal skills.
• Thorough understanding of managed care contracts.

Responsibilities

• Manage relationships with LTSS and HCBS providers.
• Conduct training and education for assigned providers.
• Respond to provider inquiries and support issue resolution.

Skills

Critical thinking

Problem solving

Interpersonal skills

Relationship management

Time management

Education

Bachelor’s Degree

Tools

Microsoft Office

Job description

Become a part of our caring community and help us put health first

The Provider Relations Representative (Provider Engagement Professional 2) is responsible for day-to-day front line relationship management of network providers in Humana’s Healthy Horizons in Virginia Medicaid network. This role supports provider onboarding, training, education, and inquiry/issue support resolution. This role specifically supports long-term services and supports (LTSS) and home and community-based services (HCBS) providers and must be based in Virginia. The individual in this role should have critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.

Become a part of our caring community and help us put health first

The Provider Relations Representative (Provider Engagement Professional 2) is responsible for day-to-day front line relationship management of network providers in Humana’s Healthy Horizons in Virginia Medicaid network. This role supports provider onboarding, training, education, and inquiry/issue support resolution. This role specifically supports long-term services and supports (LTSS) and home and community-based services (HCBS) providers and must be based in Virginia. The individual in this role should have critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.

• Serve as primary relationship manager with assigned LTSS and HCBS 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 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 Humana’s policies and procedures and Cardinal Care programmatic updates
• Coordinate regional provider townhalls and/or trainings
• Attend Network Meetings/Conferences
• Ensure compliance with all Virginia managed care contractual requirements for provider relations, s uch as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc.

Use your skills to make an impact

Required Qualifications

• 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education)
• Experience working with LTSS and/or HCBS provider operations, building strong relationships with provider organizations, financial/contracting arrangements, and/or regulatory requirements
• Exceptional relationship management and interpersonal skills
• Proficiency in analyzing, understanding, resolving, and communicating complex issues
• Exceptional time management and ability to manage multiple priorities in a fast-paced environment
• Thorough understanding of managed care contracts, including contract language and reimbursement
• Exceptional written and verbal communication skills
• Strong presentation and facilitation skills
• Knowledge of Microsoft Office applications
• Position is field based in Virginia and requires frequent travels to provider and Humana locations

Preferred Qualifications

• Bachelor’s Degree
• Experience with Virginia Medicaid
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution
• Understanding of service coordination, prior authorizations, and other health plan processes
• Understanding of value-based payment programs

Additional Information

• Position must be in one of six regions within Virginia (Tidewater, Central/Richmond, Western/Charlottesville, Northern/Winchester, Roanoke/Alleghany, Southwest)

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 yearThis 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 all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

About the company

Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs

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