Provider Engagement Professional Physical Health

Description

Humana Healthy Horizons in Oklahoma is seeking a Provider Engagement Professional 2 who develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

Responsibilities

Job Description

The Provider Relations Representative- Primary Care Physicians (PCP)/Medical Providers is responsible for day-to-day front line relationship management for network providers in Humana’s Healthy Horizons in Oklahoma’s Medicaid Plan, including provider onboarding, training, education, responding to provider inquiries, and resolving issues or complaints. This role will support providers in their designated region and must be based in Oklahoma.  The role will require critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.   

Key Role Objectives 

• Serve as primary relationship manager with providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention 

• Meet 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. 

• Support new assigned providers with onboarding, including orientation session(s) 

• Respond to assigned provider questions or inquires, and if necessary, ensure 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 Oklahoma Medicaid plan 

• Convene 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 

• Communicate updates on Humana’s policies and procedures and Oklahoma’s SoonerSelect programmatic updates  

• Coordinate regional provider townhalls and/or trainings 

• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Oklahoma Medicaid plan 

• Ensure compliance with Oklahoma’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes 

               

Required Qualifications

• Must reside in Oklahoma

• 2 or more years of health care or managed care experience working with providers (e.g., provider relations, claims education) 

• Experience working with or in health care administration setting 

• Exceptional relationship management and interpersonal skills 

• Proficiency in analyzing, understanding, and communicating complex issues 

• Exceptional time management and ability to manage multiple priorities in a fast-paced environment 

• Knowledge of Microsoft Office applications

• Must be passionate about contributing to an organization focused on continuously improving provider experiences 

• Position is field-based in Oklahoma and requires frequent travels to provider and Humana locations  

Preferred Qualifications

• Bachelor’s Degree 
• Experience with Oklahoma Medicaid  
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution 
• Understanding of managed care contracts, including contract language and reimbursement 

 

Additional Information

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