Remote Provider Relations Specialist

Humana; Springfield (IL); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work option

Job summary

Humana is seeking a Provider Relations Representative to manage day-to-day relationships with network providers in Illinois. You will onboard, train, educate, and resolve provider inquiries, striving for an Exceptional Experience across Humana’s programs.

The role requires frequent travel within Illinois, strong interpersonal skills, and a solid understanding of managed care operations and contracts. This field-based position emphasizes provider engagement and education.

Qualifications

• 2+ years of health care or managed care experience working with providers.
• Experience with Illinois Medicaid.
• Experience with Behavioral Health providers and Community Mental Health Centers.
• Exceptional relationship management and interpersonal skills.
• Thorough understanding of managed care contracts and reimbursement.

Responsibilities

• Serve as primary relationship manager with assigned providers to ensure positive provider experience with Humana’s Dual Fully Integrated and Healthy Horizon plan of Illinois.
• Conduct in-person and virtual training and education for providers, including annual trainings and policy updates.
• Support onboarding for newly assigned providers and host orientation sessions.
• Respond to provider inquiries and support prompt issue resolution with enterprise teams as needed.
• Coordinate provider townhalls and trainings; convene regular meetings to discuss operational, clinical, and quality topics.
• Educate providers on processes including claims submissions, authorizations, referrals, and provider materials.
• Communicate updates on Humana policies and programmatic changes.
• Travel locally to provider and Humana locations as required.

Skills

Relationship management

Healthcare experience

Training delivery

Communication skills

Problem solving

Tools

Availity

Job description

Humana is seeking a Provider Relations Representative to manage day-to-day relationships with network providers in Illinois. You will onboard, train, educate, and resolve provider inquiries, striving for an Exceptional Experience across Humana’s programs.

The role requires frequent travel within Illinois, strong interpersonal skills, and a solid understanding of managed care operations and contracts. This field-based position emphasizes provider engagement and education.