Provider Relations Representative, LTSS/BH

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

📋 Description

• Oversee daily interactions with designated LTSS and HCBS network providers

• Assist with provider onboarding, training, education, and resolution of inquiries and issues

• Foster a positive experience for providers and ensure network retention

• Conduct regular meetings with providers, both in-person and virtually

• Provide annual training sessions, updates on policies and procedures, and training on Humana systems

• Facilitate orientation sessions for newly assigned providers

• Work collaboratively with enterprise teams on claims, prior authorizations, referrals, reimbursement, and provider enrollment matters

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

• Educate providers on materials and operational processes that affect them

• Organize provider meetings, including agendas, materials, and minutes

• Coordinate regional provider town halls and training events

• Participate in network meetings and conferences

• Ensure adherence to Virginia's managed care contractual obligations

⛳️ Requirements

• Must be a resident of Virginia

• Bachelor's degree or 1–5 years of experience in healthcare or managed care related to provider contracting, network management, or provider relations

• Demonstrated skills in planning, preparation, and presentation

• Understanding of reimbursement and bonus systems

• Capability to handle multiple projects and meet deadlines

• Master’s degree is preferred

• Preferred proficiency in analyzing and interpreting financial trends related to healthcare costs, administrative expenses, and quality/bonus performance

• Comprehensive understanding of Medicare policies, processes, and procedures is preferred

• Experience with Medicaid electronic visit verification (EVV) is preferred

• Minimum internet speed of 25 Mbps for downloads and 10 Mbps for uploads is required

• A dedicated workspace free from interruptions is necessary to protect member PHI/HIPAA information

🏝️ 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

• Long-term disability

• Life insurance

• Self-provided internet service for home employees

• Remote work arrangement

• Occasional travel to Humana's offices for training or meetings