Senior Provider Engagement Professional - Myrtle Beach SC

Profile

Description

The Senior Provider Engagement Professional 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 Senior Provider Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Engagement Professional represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Bachelor's Degree

3 or more years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience

Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies

Demonstrated ability to manage multiple projects and meet deadlines

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

Valid driver's license with reliable transportation and the ability and willingness to travel to providers within the region up to 50% of the time

Preferred Qualifications

Master's Degree

Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance

Experience working with population health management

Comprehensive knowledge of Medicare policies, processes and procedures

Understanding of Medicaid in South Carolina

Additional Information

This position is considered remote/work at home, however, you must live in South Carolina in order to be considered for this opportunity with the ideal candidate being located in the Myrtle Beach area.

Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com