Provider Relations Representative, LTSS/BH

Humana Inc; Virginia (IL); Hybrid; USD 59,000 - 81,000; Full time

Job summary

Humana Inc. is seeking a Provider Relations Representative to manage day-to-day relationships with LTSS and HCBS providers in the Virginia Medicaid network.

The role includes onboarding, training, education, and prompt issue resolution to ensure a positive provider experience and network retention. You will collaborate with claims, enrollment, and other teams, hosting orientation sessions and regular meetings to discuss operational, clinical, and quality topics, while educating providers on

Qualifications

• Bachelors degree or 1 5 years in health care with provider relations experience.
• Strong planning, preparation and presenting skills; knowledge of reimbursement and bonus methodologies.
• Ability to manage multiple projects and meet deadlines.

Responsibilities

• 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 annual trainings and updates to Humana policies and procedures
• Support newly assigned providers with onboarding, including hosting orientation sessions
• Respond to assigned provider inquiries and support prompt issue resolution with enterprise teams (claims, prior authorizations & referrals)
• Work with internal resources and systems to provide Exceptional Experience in all provider interactions
• Create provider trainings based on provider feedback and trends in claims or process changes
• Educate providers on location and content of all provider facing materials
• Convene regular meetings with providers and organize agendas/minutes with teams to discuss operational topics
• Educate on processes including claims submissions, recoupments, authorizations, referrals, etc.
• Communicate updates on Humana policies and Cardinal Care programmatic updates
• Coordinate regional provider townhalls/trainings
• Attend Network Meetings/Conferences
• Ensure compliance with Virginia managed care contractual requirements for provider relations
• Use your skills to make an impact

Skills

Relationship management

Training and education delivery

Provider onboarding

Problem solving

Interpersonal skills

Health plan operations understanding

Education

Bachelor's degree

Tools

Availity

Claims systems

Provider enrollment systems

Job description

Become a part of our caring community

The Provider Relations Representative (Provider Engagement Professional) 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, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc
• Use your skills to make an impact

Required Qualifications

• Must reside in Virginia (SW region includes, Lee, Wise, Washington and Galax)
• Bachelors degree OR 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
• Demonstrated ability to manage multiple projects and meet deadlines

Preferred Qualifications

• Master's Degree
• Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
• Comprehensive knowledge of Medicare policies, processes and procedures
• Experience with Medicaid electronic visit verification (EVV)

Work from Home Requirements:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:

While this is a remote position, occasional travel to Humana's 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

• 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana, Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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.