Provider Relations Representative, LTSS/BH

🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $59.3k - $80.9k / year

⏰ Full Time

🟢 Junior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Manage day-to-day relationships with assigned LTSS and HCBS network providers • Support provider onboarding, training, education, and inquiry and issue resolution • Promote positive provider experience and network retention • Conduct regular in-person and virtual provider meetings • Deliver annual trainings, policy and procedure updates, and Humana systems training • Host orientation sessions for newly assigned providers • Collaborate with enterprise teams on claims, prior authorizations, referrals, reimbursement, and provider enrollment issues • Create provider trainings based on feedback, claims trends, and process changes • Educate providers on provider-facing materials and operational processes • Organize provider meetings, agendas, materials, and minutes • Coordinate regional provider town halls and trainings • Attend network meetings and conferences • Ensure compliance with Virginia managed care contractual requirements

🎯 Requirements

• Must reside in Virginia • Bachelor's degree OR 1–5 years of healthcare or managed care experience with provider contracting, network management, or provider relations • Proven planning, preparation, and presenting skills • Knowledge of reimbursement and bonus methodologies • Ability to manage multiple projects and meet deadlines • Master's degree preferred • Proficiency in analyzing and interpreting financial trends for healthcare costs, administrative expenses, and quality/bonus performance preferred • Comprehensive knowledge of Medicare policies, processes, and procedures preferred • Experience with Medicaid electronic visit verification (EVV) preferred • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated work space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ 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 • Self-provided internet service for home employees • Remote work arrangement • Occasional travel to Humana's offices for training or meetings