Provider Relations Representative

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $65.2k - $89k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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 LTSS providers • Promote network retention and a positive provider experience for Humana’s Dual Fully Integrated plan of Illinois • Meet regularly with providers in person and virtually to conduct required trainings, policy updates, and systems training • Support provider onboarding and host orientation sessions • Respond to provider inquiries and support prompt issue resolution • Collaborate with enterprise teams including claims payment, prior authorizations, and referrals • Use claims, reimbursement, and provider enrollment resources and systems to support provider interactions • Create provider trainings based on feedback, claims trends, and process changes • Educate providers about provider-facing materials and resources • Organize and facilitate provider meetings, agendas, materials, and minutes • Educate providers on claims, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, quality resources, and member resources • Communicate Humana policy, procedure, and Cardinal Care program updates • Coordinate regional provider town halls and trainings • Attend network meetings and conferences • Ensure compliance with Illinois managed care contractual requirements for provider relations

🎯 Requirements

• Must reside in Illinois • Field-based position in Illinois requiring 50% travel within Illinois • 2 or more years of healthcare or managed care experience working with providers • Experience working with LTSS providers, skilled nursing facilities, and atypical provider types • Experience in provider operations, provider organization relationship management, financial or contracting arrangements, and/or regulatory requirements • Exceptional relationship management and interpersonal skills • Ability to analyze, understand, resolve, and communicate complex issues • Thorough understanding of managed care contracts, including contract language and reimbursement • Strong presentation and facilitation skills • Preferred: experience with Illinois Medicaid • 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 • Valid state driver's license • Proof of personal vehicle liability insurance with at least 100/300/100 limits • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information • Ability to work Monday–Friday, 8:00 am–5:00 pm CST

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Mileage reimbursement for work-related travel • Remote/home workstyle • Flexible use of Humana office space as needed for collaboration and face-to-face needs