Provider Relations Representative

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $59.3k - $80.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Serve as primary relationship manager for assigned providers to ensure a positive provider experience and promote network retention • Meet regularly, both in-person and virtually, with assigned providers for training and education • Support newly assigned providers with onboarding and host orientation sessions • Respond to provider inquiries and support prompt issue resolution • Collaborate with enterprise business teams such as claims payment, prior authorizations, and referrals • Use internal resources and systems, including claims, reimbursement, and provider enrollment systems • Create provider trainings based on feedback, claims trends, and process changes • Educate providers on provider-facing materials • Organize and convene regular provider meetings, including agendas, materials, and minutes • Educate providers on claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, quality resources, and member resources • Communicate Humana policy and procedure updates and Cardinal Care programmatic updates • Coordinate regional provider town halls and trainings • Attend network meetings and conferences • Ensure compliance with Virginia managed care contractual requirements for provider relations

🎯 Requirements

• Candidate must reside within Cook County in Illinois • 2 or more years of health care or managed care experience working with providers • 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/contracting arrangements, and/or regulatory requirements • Exceptional relationship management and interpersonal skills • Thorough understanding of managed care contracts, including contract language and reimbursement • Position is field based in Illinois and requires frequent travel to provider and Humana locations • Valid state driver's license • Maintain personal vehicle liability insurance meeting applicable minimum requirements • Required to undergo tuberculosis (TB) screening • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Preferred: Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution • Preferred: Understanding of service coordination, prior authorizations, and other health plan processes • Preferred: Understanding of value-based payment programs

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Dedicated home workspace and internet requirements for remote work • Occasional travel to Humana offices for training or meetings

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