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Humana Gold Plus Integrated is seeking Provider Engagement Professionals (Physician and LTSS) who are responsible for day-to-day, front-line relationship management for network providers in Humana. This role supports provider onboarding, training, education, and inquiry/issue support and resolution. The individuals in this role should have critical thinking/problem solving skills, an understanding of health plan operations, and strong interpersonal skills. The Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems.

The Provider Engagement Professional (Physician and LTSS) roles and responsibilities include:

+ Serve as primary relationship manager with assigned providers to ensure positive provider experience with Humana’s Dual Fully Integrated plan of Illinois 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 periodic 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 live in the State of Illinois** and be able to travel throughout Illinois as needed for role.

+ 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education).

+ Experience working with physical health providers, facilities, ancillary providers, and/or FQHCs.

+ Experience working with Illinois Medicaid.

+ Experience in 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, along with strong presentation and facilitation skills.

+ Intermediate to advanced knowledge of Microsoft Office Suite applications, specifically Word, Excel, 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

+ Bachelor’s Degree.

+ 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.

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.

+ Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided with a bi-weekly payment for their internet expense.

+ 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: Field-based** ; must live in the State of Illinois.

+ **Travel:** **Up to 75% travel in the field across the state of Illinois to provider offices and Humana locations.**

+ **Core Workdays & Hours:** Typically, 8-5 pm Monday – Friday Central Standard Time (CST) with flexible scheduling (i.e. occasional nights and weekends).

Interview Format

As part of our hiring process, we will be using exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

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

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.

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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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.