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

The Senior Provider Relations Professional is responsible for fostering positive, long-term relationships with network providers that participate in Michigan’s Humana Medicaid Program. Day-to-day work includes conducting provider orientations and onboarding, managing and responding to escalated issues for network providers, conducting ongoing education including provider training, education, and hosting Joint Operating Committee or other meetings with providers. Senior Provider Relations Professionals manage work assignments that involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The role will require critical thinking/problem solving skills, keen understanding for health plan operations, and strong interpersonal skills.

Role Overview

• Foster positive provider experience for assigned providers in Humana Michigan Medicaid Program.
• Manage onboarding and orientations for new providers to Humana’s network.
• Conduct ongoing education and training to support Humana Michigan Medicaid Program network providers in self-service functions - such as eligibility confirmation, claims submission and payment - by use of available tools.
• Schedule, prepare and facilitate Joint Operating Committee or other provider meetings, at times in partnership with other market and/or enterprise teams.
• Ensure prompt resolution of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, referrals and state or Commissioner of Insurance inquiries.
• ·Create and/or deliver trainings and educational materials for Humana Michigan Medicaid providers on Humana processes and procedures and location of all content on website.
• Participate and/or speak at Town Halls, webinars, or other forums to communicate important policy or programmatic updates to providers.
• Ensure compliance with Michigan managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes.
• Schedule, prepare and complete on-site provider location visits to nurture relationships; attend association conferences, as necessary.
• Obtain and relay accurate required credentialing documents to credentialing team​ from the provider.

Use your skills to make an impact

Required Qualifications

• 3+ years of health care or managed care experience working with providers (e.g., provider relations, claims education).
• Experience with Michigan Medicaid
• Knowledge of Microsoft Office applications.
• Demonstrated ability to manage multiple projects and meet deadlines.
• Exceptional relationship management skills.
• Experience handling escalated or highly visible provider complaints/issues to resolution.
• Understanding of health insurance claims and ability to analyze data to resolve provider service issues.
• Excellent written and verbal communication skills.
• Proficiency in analyzing, understanding, and communicating complex issues.
• Exceptional time management and ability to manage multiple priorities in a fast-paced environment.
• The applicant must be located in or willing to relocate to the Metro Detroit area.

Preferred Qualifications

• Bachelor’s Degree.
• Experience working for or with key provider types (primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers).
• Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Experience with service coordination, prior authorizations, and other health plan processes.

Travel

• 3-5 days a week – Metro Detroit Area
• Must have a Valid driver’s license with reliable transportation and the ability to travel within the state, as required
• This role is 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.

Additional 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 required.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward with the screening process, you will receive a link to record your answers on video. Please give yourself time to prepare for the video screening.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

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.

$71,100 - $97,800 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.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.