Become a part of our caring community and help us put health first
 

The Senior Provider Relations Professional is responsible for fostering positive, long-term relationships with network providers that participate in Michigan’s Humana Medicaid Program. Day-to-day work includes conducting provider orientations and onboarding, managing and responding to escalated issues for network providers, conducting ongoing education including provider training, education, and hosting Joint Operating Committee or other meetings with providers. Senior Provider Relations Professionals manage work assignments that involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The role will require critical thinking/problem solving skills, keen understanding for health plan operations, and strong interpersonal skills.

Role Overview

• Foster positive provider experience for assigned providers in Humana Michigan Medicaid Program.
• Manage onboarding and orientations for new providers to Humana’s network.
• Conduct ongoing education and training to support Humana Michigan Medicaid Program network providers in self-service functions - such as eligibility confirmation, claims submission and payment - by use of available tools.
• Schedule, prepare and facilitate Joint Operating Committee or other provider meetings, at times in partnership with other market and/or enterprise teams.
• Ensure prompt resolution of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, referrals and state or Commissioner of Insurance inquiries.
• ·Create and/or deliver trainings and educational materials for Humana Michigan Medicaid providers on Humana processes and procedures and location of all content on website.
• Participate and/or speak at Town Halls, webinars, or other forums to communicate important policy or programmatic updates to providers.
• Ensure compliance with Michigan managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes.
• Schedule, prepare and complete on-site provider location visits to nurture relationships; attend association conferences, as necessary.
• Obtain and relay accurate required credentialing documents to credentialing team​ from the provider.

Use your skills to make an impact
 

Required Qualifications

• 3+ years of health care or managed care experience working with providers (e.g., provider relations, claims education).
• Experience with Michigan Medicaid
• Knowledge of Microsoft Office applications.
• Demonstrated ability to manage multiple projects and meet deadlines.
• Exceptional relationship management skills.
• Experience handling escalated or highly visible provider complaints/issues to resolution.
• Understanding of health insurance claims and ability to analyze data to resolve provider service issues.
• Excellent written and verbal communication skills.
• Proficiency in analyzing, understanding, and communicating complex issues.
• Exceptional time management and ability to manage multiple priorities in a fast-paced environment.
• The applicant must be located in or willing to relocate to the Metro Detroit area.

Preferred Qualifications

• Bachelor’s Degree.
• Experience working for or with key provider types (primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers). 
• Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Experience with service coordination, prior authorizations, and other health plan processes.

Travel

• 3-5 days a week – Metro Detroit Area
• Must have a Valid driver’s license with reliable transportation and the ability to travel within the state, as required
• This role is 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.

Additional Information

Work At Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Monta