Provider Education amp Outreach Representative LTSS Medicaid

Profile

Description

Humana Healthy Horizons in Indiana is seeking two Provider Education & Outreach Representatives (Provider Engagement Professional 2) who will be responsible for the day-to-day front line relationship management of network providers for Humana's Healthy Horizons in Indiana. At least one of the Provider Education & Outreach Representatives (Provider Engagement Professional 2) will specialize in supporting Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) providers. They will be responsible for provider onboarding, training, education, responding to provider inquiries, and resolving issues or complaints.

Responsibilities

Serves as primary relationship manager with LTSS and HCBS providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention.

Meets 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.

Supports new assigned providers with onboarding, including orientation session(s).

Responds 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 Indiana Medicaid plan.

Communicates updates on Humana's policies and procedures and Indiana Pathways for Aging programmatic updates.

Coordinates regional provider townhalls and/or trainings.

Works with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana's Indiana Medicaid plan on behalf of assigned providers.

Required Qualifications

Must reside in the state of Indiana.

Must be able to travel in the state of Indiana to provider offices and Humana locations.

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

Experience working for or with key provider types (primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers); For the Provider Education & Outreach Representatives specializing in LTSS and HCBS providers, experience working with LTSS and HCBS providers is required.

Knowledge of Microsoft Office applications.

Exceptional relationship management and interpersonal skills

Proficiency in analyzing, understanding, and communicating complex issues.

Knowledge of Microsoft Office applications

This role is a 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.

This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Preferred Qualifications

Bachelor's Degree.

Experience with Indiana Medicaid.

Understanding of managed care contracts, including contract language and reimbursement.

Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.

Understanding of service coordination, prior authorizations, and other health plan processes.

Work at Home Requirements

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.

Additional Information:

Workstyle: Remote but may vary due to travel and occasional onsite work at the Humana Healthy Horizons office in Indiana.

Travel: Up to 50% travel in the state of Indiana to provider offices and Humana locations.

Core Workdays & Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).

Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

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.

Social Security Task

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

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