Provider Relations Professional

Overview

Become a part of our caring community and help us put health first. The Provider Relations/Engagement Professional 2 develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. You will report to Associate Director Provider Relations and support the Louisiana Medicaid Physical Health team.

• Conduct in-person and virtual provider engagements to support education on policies, processes, and available tools, including navigating online resources; monitor relevant reports and document provider interactions following established requirements.
• Support departmental, segment, and organizational strategies by aligning day-to-day activities with defined operating goals and cross-functional programs.
• Plan and execute assigned work, including navigating routine ambiguity, while escalating issues and seek guidance.
• Contribute to programs focused on improving provider and consumer experiences through participation in engagement activities and process awareness, following established guidelines, procedures, and documentation standards.

• 1 year of health care or managed care with Provider Contracting, Network Management or Provider Relations experience
• Intermediate to advanced Microsoft Word, Excel, Outlook, and PowerPoint skills demonstrated by creating complex documents, spreadsheets, presentations, and email communications required for role functions
• Successfully demonstrated effective planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
• Experience conducting face-to-face and virtual meetings with healthcare providers to educate them on organizational policies and processes, foster professional relationships, instruct providers on the use of online tools and resources, monitor relevant reports, and accurately document provider interactions
• Experience managing multiple projects or assignments concurrently within a professional or academic setting, utilizing structured project tracking or project management tools
• Prior experience establishing and maintaining professional relationships with provider offices, hospitals, and community organizations, demonstrated by coordination and participation in conferences, seminars, town halls, and other community-based events

• Experience working with Medicare/Medicaid or other MCO

Driving Statement This role is part of our company's driver safety program and requires a valid state driver’s license and maintenance of personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 per event /$10,000 for property damage or whichever is higher.

Work-At-Home Requirements To ensure Home or Hybrid Home/Office associates can work effectively, self-provided internet service must meet criteria:

• Download speed of at least 25 Mbps and upload speed of 10 Mbps; wireless, wired cable or DSL connection required.
• Satellite, cellular and microwave connections can be used only if approved by leadership.
• Associates in California, Illinois, Montana, or South Dakota may receive a bi-weekly internet expense payment.
• Humana provides home/Hybrid Home/Office associates with telephone equipment appropriate to meet business requirements.
• Work from a dedicated space with minimal interruptions to protect member PHI/HIPAA information.

Workstyle: Combination remote work at home and onsite/home member visits

Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM; overtime may be requested to meet business needs and requires approval.

Travel: Travel for field visits to meet with providers in your region, based on the Provider tier level. Positions are available in Region 4 (Louisiana parishes: Lafayette, Evangeline, St. Landry, St. Martin, Iberia, Vermillion, Acadia) and Region 5 (parishes: Calcasieu, Jefferson Davis, Cameron, Allen, Beauregard).

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