Provider Relations Representative, LTSS/BH
Tazewell, VAAll locationsTazewell, VARemote VirginiaGalax, VABristol, VA Remote
$59,300–$80,900 a yearJobFig found this opening at its original source and checks that it remains available.
About the role
The Provider Relations Representative (Provider Engagement Professional) is responsible for day-to-day front line relationship management of network providers in Humana's Healthy Horizons in Virginia Medicaid network. This role supports provider onboarding, training, education, and inquiry/issue support resolution. This role specifically supports long-term services and supports (LTSS) and home and community-based services (HCBS) providers and must be based in Virginia. The individual in this role should have critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.
What you'll bring
- Must reside in Virginia (SW region includes, Lee, Wise, Washington and Galax)
- Bachelors degree OR 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
- Demonstrated ability to manage multiple projects and meet deadlines
- Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
- Master's Degree
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
- Comprehensive knowledge of Medicare policies, processes and procedures
- Experience with Medicaid electronic visit verification (EVV)
- In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
- 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.