Provider Engagement Professional

CenterWell•Work at Home - Florida, FL

1d•$59,300 - $80,900•Remote

About The Position

The Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance within their contracted relationships with the health plan. Assignments are varied and frequently require interpreting information and independently determining appropriate courses of action. The position reports to the Director, Provider Engagement. The role represents the health plan/provider relationship across financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements, and other areas affecting provider performance, member experience, provider experience, market growth, and operational excellence. The position also requires understanding department, segment, and organizational strategies and operating objectives and their connections to related areas. This is a remote position based out of a home office, with travel to provider offices approximately 3–4 days per week. Occasional travel to Humana offices for training or meetings may also be required. The role is scheduled for 40 hours per week.

Requirements

Bachelor's degree.
1–5 years of healthcare or managed care experience in Provider Contracting, Network Management, or Provider Relations.
Experience working with service fund reports.
Planning, preparation, and presentation skills, with established knowledge of reimbursement and bonus methodologies.
Ability to manage multiple projects and meet deadlines.
Passion for contributing to an organization focused on continuously improving consumer experiences.
For home-based work, self-provided internet service must have at least 25 Mbps download and 10 Mbps upload speed; wireless, wired cable, or DSL is suggested.
Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

Master's degree.
Proficiency in analyzing and interpreting financial trends for healthcare costs, administrative expenses, and quality/bonus performance.
Comprehensive knowledge of Medicare policies, processes, and procedures.

Responsibilities

Develop and grow positive, long-term relationships with physicians, providers, and healthcare systems.
Support and improve financial and quality performance within contracted health plan relationships.
Represent the health plan/provider relationship across financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and operational improvements.
Address areas related to provider performance, member experience, provider experience, market growth, and operational excellence.
Interpret varied assignments and independently determine appropriate courses of action.
Understand department, segment, and organizational strategies and operating objectives, including connections to related areas.
Travel to provider offices approximately 3–4 days per week and occasionally to Humana offices for training or meetings.