Provider Engagement Professional

Humana•Work at Home - Indiana, IN

6d•$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 Humana Healthy Horizons in Indiana’s Medicaid Plan. This role manages day-to-day relationships with physical and behavioral health providers in an assigned region, including onboarding, training, education, responding to inquiries, and resolving issues or complaints. The position supports providers across Indiana and requires the employee to reside in Indiana. It reports to the Provider Engagement Manager. This is a remote role with frequent travel to providers and Humana locations, up to 25%, and occasional travel to Humana offices for training or meetings. Employees working from home must have a dedicated space that prevents ongoing interruptions and protects member PHI/HIPAA information. Home internet service must provide at least 25 Mbps download and 10 Mbps upload; wireless, wired cable, or DSL is suggested. The scheduled weekly hours are 40.

Requirements

Must reside in Indiana.
Requires frequent travel to providers and Humana locations, up to 25%.
At least 2 years of healthcare or managed care experience working with physical health and behavioral health providers.
Experience training and educating providers.
Experience delivering formal presentations using PowerPoint.
Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
Knowledge of Microsoft Office applications, including Excel features such as pivot tables and macros.

Nice To Haves

Bachelor's degree.
Experience with Indiana Medicaid.
Experience working with behavioral health providers, facilities, and/or FQHCs.
Understanding of managed care contracts, including contract language and reimbursement.

Responsibilities

Serve as the primary relationship manager for physical and behavioral health providers, supporting a positive provider experience and network retention.
Meet regularly with assigned providers, both in person and virtually, to provide training and education, including required annual trainings, explain Humana systems, and promote understanding of Humana policies and procedures.
Support onboarding of newly assigned providers, including orientation sessions.
Respond to provider questions and inquiries and coordinate prompt resolution of provider issues with appropriate enterprise teams, including claims payment, prior authorizations, and referrals.
Convene Service Operating Committee meetings with providers and organize agendas, materials, and participating team members.
Communicate updates to Humana policies and procedures and Indiana program requirements.
Coordinate regional provider town halls and/or trainings.
Work with internal resources and systems, including claims, reimbursement, and provider enrollment.
Ensure compliance with Indiana managed care contractual provider-relations requirements, including claims dispute resolution within specified timeframes.