Provider Relations Representative

Humana•Chicago, IL

3d•$59,300 - $80,900•Remote

About The Position

The Provider Relations Representative manages day-to-day relationships with assigned behavioral health (BH) network providers for Humana’s Dual Fully Integrated and Healthy Horizon plan of Illinois. The role supports provider onboarding, training, education, inquiry response, and issue resolution, while promoting a positive provider experience and network retention. It requires critical thinking, problem-solving, health plan operations knowledge, and strong interpersonal and relationship-management skills. This is a remote, field-based position in Illinois, with frequent travel to provider and Humana locations and occasional travel to Humana offices for training or meetings. The position is patient-facing and subject to Humana’s TB screening program. It is also subject to Humana’s driver safety program, requiring a valid state driver’s license and personal vehicle liability insurance that meets the applicable minimum limits. Home or hybrid home/office work requires internet service with at least 25 Mbps download and 10 Mbps upload, and a dedicated space that protects member PHI/HIPAA information. The position is scheduled for 40 hours per week. The stated annual base-pay range is $59,300–$80,900, with eligibility for a bonus incentive plan based on company and/or individual performance.

Requirements

Must reside within Cook County, Illinois.
At least 2 years of health care or managed care experience working with providers, such as provider relations or claims education.
Experience with Illinois Medicaid.
Experience working with behavioral health providers and Community Mental Health Centers.
Experience in provider operations, building strong relationships with provider organizations, financial or contracting arrangements, and/or regulatory requirements.
Exceptional relationship-management and interpersonal skills.
Thorough understanding of managed care contracts, including contract language and reimbursement.
Ability to travel frequently to provider and Humana locations.
Valid state driver's license and personal vehicle liability insurance meeting applicable requirements.
Ability to meet the home-work internet requirements of at least 25 Mbps download and 10 Mbps upload, and work from a dedicated space that protects member PHI/HIPAA information.
Must complete TB screening if selected for the patient-facing role.

Nice To Haves

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.

Responsibilities

Serve as the primary relationship manager for assigned providers, support a positive provider experience, and promote network retention.
Meet regularly with assigned providers in person and virtually to deliver training and education, including required annual training, policy and procedure updates or reviews, and Humana systems training.
Support newly assigned providers through onboarding, including hosting orientation sessions.
Respond to provider inquiries and support prompt issue resolution, collaborating with appropriate enterprise teams when needed.
Work with internal resources and systems, including claims, reimbursement, and provider enrollment, to provide an exceptional experience in provider interactions.
Develop provider training based on provider feedback, claims trends, or process changes.
Educate providers about the location and content of provider-facing materials, including orientations, the Provider Manual, newsletters, and program updates.
Organize and convene regular provider meetings, including preparing agendas and materials, recording minutes, and coordinating other participants such as clinical and provider engagement team members.
Educate providers on claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, quality resources, and member resources.
Communicate updates to Humana policies and procedures and Cardinal Care program updates.
Coordinate periodic regional provider town halls and/or trainings.
Attend network meetings and conferences.
Ensure compliance with applicable managed care contractual requirements for provider relations, including timeframes for claims dispute resolution, provider complaints, and provider inquiry responses.