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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
The Provider Relations Professional- Behavioral Health (BH) 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 behavioral health 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 behavioral health 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
Preferred Qualifications
Bachelor’s Degree
Experience with Oklahoma Medicaid
Experience working with behavioral health providers, facilities and/or FQHCs is strongly desired
Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution
Understanding of managed care contracts, including contract language and reimbursement
Additional Information
About Humana
Your growth is what drives Humana forward.
- When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you
- This is a place where our nurses influence the C-suite
- Where software engineers change lives
- Where every associate can build a professional path where they learn and thrive
- Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security
- Because finding new ways to put health first—for our members and patients and our associates alike—is what we do
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40More Information
Application Details
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Organization Details
004 Humana Insurance Company
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