Provider Relations Representative, LTSS/BH

Become a part of our caring community   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. Serve as primary relationship manager with assigned LTSS and HCBS 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 training and education, including, but not limited to, required annual trainings, periodic updates to and/or reviews of Humana policies and procedures, and Humana systems training and updates Support newly assigned providers with onboarding, including hosting orientation session(s) Respond to assigned provider inquiries and support prompt issue resolution, including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals) Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide Exceptional Experience in all provider interactions Create provider trainings based on provider feedback, trends in claims or process changes Educate provider on location and content of all provider facing materials (Orientation, Provider Manual, Newsletter, Program Updates, Etc.) Convene regular meetings with providers, including organizing agendas, materials, meeting minutes, other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics Educate on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, Quality resources, and member resources Communicate updates on Humana's policies and procedures and Cardinal Care programmatic updates Coordinate regional provider townhalls and/or trainings Attend Network Meetings/Conferences Ensure compliance with all Virginia managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc Use your skills to make an impact   Required Qualifications 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 Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies Demonstrated ability to manage multiple projects and meet deadlines Preferred Qualifications 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) 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