Provider Engagement Professional - Behavioral Health

About this role

Become a part of our caring community   The Provider Engagement Professional 2 develops and grows positive, long-term relationships with physicians, providers, and healthcare systems. These relationships are established in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Humana Healthy Horizons in Oklahoma is seeking a Provider Engagement Professional who 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. The Provider Engagement Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Provider Relations Representative is responsible for day-to-day front line relationship management for network providers in Humana’s Healthy Horizons in Oklahoma’s Medicaid Plan, including provider onboarding, training, education, responding to provider inquiries, and resolving issues or complaints. This role will support physical and behavioral health providers in their designated region and must be based in Oklahoma.  The role will require critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.   

Key Role Objectives  • Serve as primary relationship manager with physical and behavioral health providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention 

• Meet 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. 

• Support new assigned providers with onboarding, including orientation session(s) 

• Respond to assigned provider questions or inquires, and if necessary, ensure 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 Oklahoma Medicaid plan 

• Convene Service 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 

• Communicate updates on Humana’s policies and procedures and Oklahoma’s SoonerSelect programmatic updates  

• Coordinate regional provider townhalls and/or trainings 

• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Oklahoma Medicaid plan 

• Ensure compliance with Oklahoma’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes 

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Use your skills to make an impact  

Required Qualifications • 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education) 

• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution 

• Must reside in Oklahoma

• Willing and able to travel frequently to providers and Humana locations (daily travel up to 50% of the time)

​ Preferred Qualifications • Bachelor’s Degree 

• Experience with Oklahoma Medicaid  

• Experience working with behavioral health providers, facilities and/or FQHCs is strongly desired 

• Understanding of provider contracts and credentialing, including contract language and reimbursement

Additional Information This role is considered a hybrid role that will have you working from your remote office while you are not traveling to providers and you must live in the State of Oklahoma to be considered for this opportunity.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.  

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.   $59,300 - $80,900 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, pai

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