Job Description

Become a part of our caring community and help us put health first
 

Humana Healthy Horizons in Florida is seeking a Provider Engagement Professional to join the Florida Medicaid Market Team. In this role, you will develop and grow positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan.

The Provider Engagement Professional works within specific guidelines and procedures, applies technical knowledge to solve moderately complex problems, and receives assignments in the form of objectives to determine approach, resources, schedules, and goals.

The Provider Engagement Professional serves as the primary relationship manager with providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention.

Key roles and responsibilities:

• 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.
• Serves as primary relationship manager with LTSS, Skilled Nursing Facilities, HCBS providers and/or PH and BH providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention.
• Supports new assigned providers with onboarding, including orientation session(s).
• Responds to assigned provider questions or inquires, and if necessary, ensures 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.
• Convenes Joint Operating Committee meetings with providers, including organizing agendas, materials, and other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics.

Use your skills to make an impact
 

Required Qualifications

• Must reside in Miami-Dade County within the State of Florida.
• Must be able to travel (up to 75%) in the State of Florida to provider offices and Humana locations.
• 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education).
• Experience working with LTSS, Skilled Nursing Facilities, HCBS providers and/or PH and BH providers.
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Proficiency in analyzing, understanding, and communicating complex issues.
• Exceptional time management skills and ability to manage multiple priorities in a fast-paced environment.
• Working knowledge of Microsoft Office applications, such as Word, Excel, Outlook, and PowerPoint.
• 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.

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.
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• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Bachelor’s Degree.
• Experience with Florida Medicaid and Medicare Advantage guidelines.
• Understanding of managed care contracts, including contract language and reimbursement.
• Comprehensive knowledge of claims systems, adjudication, submission processes, coding, and/or dispute resolution.

Additional Information:

• Workstyle: Remote but must live in Miami-Dade County in the State of Florida, with occasional onsite work at the Humana Healthy Horizons office in Florida.
• Travel: Up to 75% travel in the state of Florida to provider offices and Humana locations.
• Core Workdays & Hours: Typically, 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 Hire Vue, 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.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$52,500 - $72,300 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.