Provider Relations Representative

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

📋 Description

• Act as the main relationship manager for designated LTSS providers.

• Foster network retention and enhance the provider experience for Humana’s Dual Fully Integrated plan in Illinois.

• Conduct regular meetings with providers both in-person and virtually to provide essential trainings, policy updates, and systems instruction.

• Assist with provider onboarding and lead orientation sessions.

• Address provider inquiries and ensure quick resolution of issues.

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

• Utilize claims, reimbursement, and provider enrollment resources and systems to facilitate provider interactions.

• Develop provider trainings informed by feedback, claims patterns, and changes in processes.

• Inform providers about materials and resources available to them.

• Coordinate and lead provider meetings, including creating agendas, materials, and taking minutes.

• Guide providers on claims, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, quality resources, and member resources.

• Disseminate updates on Humana policies, procedures, and the Cardinal Care program.

• Organize regional provider town halls and training sessions.

• Participate in network meetings and conferences.

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

⛳️ Requirements

• Must be a resident of Illinois.

• This is a field-based role in Illinois requiring 50% travel within the state.

• At least 2 years of experience in healthcare or managed care involving provider interactions.

• Experience with LTSS providers, skilled nursing facilities, and atypical provider types is necessary.

• Background in provider operations, relationship management, financial or contracting arrangements, and/or regulatory compliance.

• Excellent relationship management and interpersonal capabilities.

• Ability to analyze, comprehend, resolve, and communicate complex issues effectively.

• Comprehensive knowledge of managed care contracts, including contract terms and reimbursement policies.

• Strong presentation and facilitation abilities.

• Preferred: experience with Illinois Medicaid.

• 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 initiatives.

• Valid driver’s license for the state.

• Evidence of personal vehicle liability insurance with minimum limits of 100/300/100.

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

• A dedicated workspace free from interruptions to safeguard PHI/HIPAA information.

• Availability to work Monday through Friday, from 8:00 am to 5:00 pm CST.

🏝️ Benefits

• Bonus incentive plan.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance.

• Mileage reimbursement for work-related travel.

• Option for remote/home workstyle.

• Flexible access to Humana office space as needed for collaboration and face-to-face interactions.