Note: The job is a remote job and is open to candidates in USA. Humana is a leading health services company dedicated to improving health outcomes. The Provider Engagement Professional 2 is responsible for building and maintaining relationships with healthcare providers to enhance financial and quality performance within the health plan.
Responsibilities
- 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
- Represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence
- Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
- Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
- Follows established guidelines/procedures
Skills
- Bachelor's Degree or equivalent experience
- 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
- Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
- Demonstrated ability to manage multiple projects and meet deadlines
- Value based care experience
- Data analysis experience
- Database care experience
- Experience with HEDIS/STARS
- MSO and Payor experience
- Must be highly service oriented
- Travel in and around Nashville, TN and Atlanta, GA markets. Primarily in and around the Nashville, TN Metro area
- Local travel 75%, Regional travel 25%, Road travel 50%
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- 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
Benefits
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
- Medical, dental and vision benefits
- 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
Company Overview
Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.
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