Provider Engagement Professional Remote Kentucky ID-12550
Humana Healthy Horizons in Kentucky is seeking a Provider Engagement Professional to join the Medicaid Market Team. In this role, you will develop and grow positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan.
The Provider Engagement Professional works within specific guidelines and procedures, applies technical knowledge to solve moderately complex problems, and receives assignments in the form of objectives to determine approach, resources, schedules, and goals.
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The Provider Engagement Professional serves as the primary relationship manager with providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention.
Key roles and responsibilities:
- Meets 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.
- Serves as primary relationship manager with Physical Health and/or Behavioral Health providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention.
- Supports new assigned providers with onboarding, including orientation session(s).
- Responds to assigned provider questions or inquires, and if necessary, ensures 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 Kentucky Medicaid plan.
- Convenes or participates in service Operations meetings with providers, including organizing agendas, materials, and other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics.
Use your skills to make an impact
Required Qualifications
- Must reside in the State of Kentucky and be to travel up to 50% within the state to provider offices and Humana locations.
- Bachelors Degree.
- 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education).
- Experience working with Physical Health and Behavioral Health providers.
- Experience working with Medicaid policies and/or health plans.
- Proven experience preparing and delivering presentations to large and small provider groups, members of leadership teams, and business partners.
- Exceptional time management skills and ability to manage multiple priorities in a fast-paced environment.
- Working knowledge of Microsoft Office applications, such as Word, Excel, Outlook, and PowerPoint.
- This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Preferred Qualifications
- Masters Degree.
- Comprehensive knowledge of Kentucky Medicaid policies, processes, and procedures.
- Understanding of Kentucky managed care contracts, including contract language and reimbursement.
- Comprehensive knowledge of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
Work at Home Requirements
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Additional Information:
- Workstyle: Remote but must live in the State of Kentucky with occasional onsite work at the Humana Healthy Horizons office in Kentucky.
- Travel: Up to 50% travel in the State of Kentucky to provider offices and Humana locations.
- Core Workdays & Hours: Typically, Monday – Friday 8:00am – 5:00pm Eastern Standard Time (EST).
- Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....
