Provider Relations Representative

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Act as the main relationship manager for designated providers to foster a positive provider experience and enhance network retention.

• Conduct regular meetings, both in-person and online, with assigned providers for training and educational purposes.

• Assist newly assigned providers with their onboarding process and facilitate orientation sessions.

• Address provider inquiries and facilitate prompt resolution of issues.

• Collaborate with enterprise business teams, including claims payment, prior authorizations, and referrals.

• Utilize internal resources and systems, such as claims, reimbursement, and provider enrollment platforms.

• Develop provider training sessions based on feedback, claims trends, and changes in processes.

• Inform providers about materials directed towards them.

• Schedule and manage regular provider meetings, including preparation of agendas, materials, and meeting minutes.

• Provide education to providers regarding claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, quality resources, and member resources.

• Communicate updates on Humana policies and procedures as well as Cardinal Care programmatic changes.

• Organize regional provider town halls and training sessions.

• Participate in network meetings and conferences.

• Ensure adherence to Virginia managed care contractual obligations regarding provider relations.

⛳️ Requirements

• Candidates must reside within Cook County, Illinois.

• At least 2 years of experience in health care or managed care working with providers.

• Familiarity with Illinois Medicaid.

• Experience working with Behavioral Health providers and Community Mental Health Centers.

• Background in provider operations, establishing strong relationships with provider organizations, financial/contracting arrangements, and/or regulatory requirements.

• Outstanding relationship management and interpersonal skills.

• Comprehensive understanding of managed care contracts, including contract language and reimbursement processes.

• This position is field-based in Illinois and entails frequent travel to provider and Humana locations.

• A valid state driver's license is required.

• Must maintain personal vehicle liability insurance that meets applicable minimum requirements.

• Required to undergo tuberculosis (TB) screening.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload is necessary.

• Must work from a dedicated space free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Preferred: Familiarity with claims systems, adjudication, submission processes, coding, and/or dispute resolution.

• Preferred: Knowledge of service coordination, prior authorizations, and other health plan processes.

• Preferred: Understanding of value-based payment programs.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance policy.

• Dedicated home workspace and internet requirements for remote work.

• Occasional travel to Humana offices for training or meetings.