About this job
Responsibilities
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 LTSS, Skilled Nursing Facilities, HCBS providers and/or PH and BH 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 Indiana Medicaid plan.
- Convenes Joint Operating Committee meetings with providers, including organizing agendas, materials, and other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics.
Required Qualifications
- Must reside in the State of Florida, specifically within the following counties: Palm Beach, Martin, Indian River, St Lucie, or Okeechobee.
- Must be able to travel (up to 75%) in the State of Florida to provider offices and Humana locations.
- 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education).
- Experience working with LTSS, Skilled Nursing Facilities, HCBS providers and/or PH and BH providers.
- Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
- Proficiency in analyzing, understanding, and communicating complex issues.
- 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.
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
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.
Preferred Qualifications
- Bachelor’s Degree.
- Experience with Florida Medicaid and Medicare Advantage guidelines.
- Understanding of managed care contracts, including contract language and reimbursement.
- Comprehensive knowledge of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
Additional Information:
- Workstyle: Remote but must live in the State of Florida with occasional onsite work at the Humana Healthy Horizons office in Florida.
- Travel: Up to 75% travel in the state of Florida 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…..
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers 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 next round of interviews.
Scheduled Weekly Hours
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Request an Accommodation
If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.
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Our Hiring Process
Apply online
To be considered for a job, you must apply online. Unfortunately, we cannot accept resumes that have been emailed to us. Once you find a job that interests you, simply select “Apply.” It typically takes 15 minutes to fill out the application form. Be sure to update your resume and upload it as you cannot edit the resume or add it after the application has been submitted. Shortly after you submit your application, you will receive a confirmation.
Next Step
If selected to continue with the interview process, you will be contacted through text or email to complete an assessment or schedule an initial live or recorded phone or video interview.
A hiring manager interview
After hiring managers and interview teams carefully consider the skills and experiences of applicants, they contact the top candidates via email or phone to schedule an interview.
Offer from Humana
If you’ve successfully completed the interview process and are identified as the candidate we would like to hire, you will receive an offer from our Talent Acquisition team.
Onboarding
If you accept the offer to join our Humana team, you will receive a welcome call or email to begin the onboarding process.
