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The Provider Relations Professional is responsible for day-to-day, front-line relationship management for network providers in Michigan’s Humana’s Dual Integrated (HMO D-SNP) Program. This role supports provider onboarding, training, education, and inquiry/issue support and resolution. The individual in this role should have critical thinking/problem solving skills, an understanding of health plan operations, and strong interpersonal skills. This role develops and grows positive, long-term relationships with physicians, providers and healthcare systems.

Position Responsibilities

Serve as primary relationship manager with assigned providers to ensure positive provider experience with Humana’s Dual Integrated (HMO D-SNP) Program and promote network retention.
Meet regularly, both in person and virtually, with assigned providers to conduct training and education, including, but not limited to, required annual trainings, periodic updates to and/or reviews of Humana policies and procedures, and Humana systems training and updates.
Support newly assigned providers with onboarding, including hosting orientation session(s).
Respond to assigned provider inquiries and support prompt issue resolution, including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals).
Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions.
Create provider trainings based on provider feedback, trends in claims or process changes.
Educate provider on location and content of all provider-facing materials (Orientation, Provider Manual, Newsletter, Program Updates, etc.).
Convene regular 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.
Educate on processes including recoupments, clinical or post pay audit, authorization issues, check/void issue process, Availity, quality resources, and member resources
Communicate updates on Humana’s policies and procedures and Humana’s Dual Integrated (HMO D-SNP) programmatic updates.
Coordinate periodic regional provider townhalls and/or trainings.
Attend network meetings/conferences.
Ensure compliance with all Michigan managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc.
Obtain and relay accurate required credentialing documents to credentialing team.

Required Qualifications

Use your skills to make an impact

Position is field based in Michigan and requires frequent travels to provider offices and Humana locations.
The applicant must be located in or willing to relocate to the Metro Detroit area.
High school diploma or equivalent.
2 or more years of health care or managed care experience working with providers (e.g., provider relations, claims education).
Experience working with or for physical health providers, facilities and ancillary providers, and/or FQHCs.
Experience working with or in health care administration setting.
Understanding of managed care contracts, including contract language and reimbursement.
Knowledge of Microsoft Office applications.
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.
Proven working knowledge of physical health provider operations, competitor strategies, financial/contracting arrangements, and/or regulatory requirements.
Exceptional written and verbal communication and relationship management skills
Strong presentation and facilitation skills.

Preferred Qualifications

Bachelor’s Degree.
Experience with Michigan Medicaid.
Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
Understanding of managed care contracts, including contract language and reimbursement.
Understanding of service coordination, prior authorizations, and other health plan processes.

Additional Information

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.
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 Process

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in an SMS Text Messaging interview and/or a pre-recorded Voice Interview. You should anticipate these interviews to take approximately 10-15 minutes.

Some candidates will subsequently be informed if you will be moving forward to next round of live virtual interviews with the hiring team.

Note: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$59,300 - $80,900 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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