Provider Relations Representative

Join our growing team as a Provider Engagement Professional supporting day-to-day, front-line relationship management for network providers at Humana. This role focuses on provider onboarding, training, education, and inquiry/issue support and resolution.

About the role

Develop and grow positive, long-term relationships with physicians, providers, and healthcare systems. Serve as the primary relationship manager for assigned LTSS providers to ensure a positive provider experience with Humana’s Dual Fully Integrated plan of Illinois and promote network retention.

Responsibilities

• Meet regularly, both in-person and virtually, with assigned providers to conduct training and education, including required annual trainings, periodic updates to 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, collaborating with appropriate enterprise business teams (e.g., claims payment, prior authorizations & referrals) as needed.
• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide an exceptional experience in all provider interactions.
• Create provider trainings based on provider feedback, trends in claims, or process changes.
• Educate providers on the 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, and involving other team members (clinical, provider engagement) to discuss key operational, clinical, and quality-related topics.
• Educate providers 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 periodic regional provider townhalls and/or trainings.
• Attend Network Meetings/Conferences.
• Ensure compliance with all Illinois managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, and provider inquiry response.

Requirements

• Must reside in Illinois.
• Position is field-based in Illinois and requires 50% travel within the state.
• 2 or more years of healthcare or managed care experience working with providers (e.g., provider relations, claims education).
• Experience working with LTSS providers, Skilled Nursing facilities, or atypical provider types.
• Experience in provider operations, building strong relationships with provider organizations, financial/contracting arrangements, and/or regulatory requirements.
• Exceptional relationship management and interpersonal skills.
• Proficiency in analyzing, understanding, resolving, and communicating complex issues.
• Thorough understanding of managed care contracts, including contract language and reimbursement.
• Strong presentation and facilitation skills.
• Valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits (mileage reimbursement provided for work-related travel).
• Self-provided internet service with a minimum download speed of 25 Mbps and upload speed of 10 Mbps (wireless, wired cable, or DSL connection suggested).

Preferred Qualifications

• Experience with Illinois Medicaid.
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.
• Understanding of service coordination, prior authorizations, and other health plan processes.
• Understanding of value-based payment programs.

Schedule

• Monday – Friday, 8:00 am – 5:00 pm CST.
• 40 scheduled weekly hours.
• Home workstyle (remote with occasional use of Humana office space for collaboration or face-to-face needs).
• Occasional travel to Humana's offices for training or meetings may be required.

Pay

The pay range for this full-time (40 hours per week) position is $65,200 - $89,000 per year. The range may be higher or lower based on geographic location, and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, and certifications. This role is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits designed to support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off (including paid holidays, parental leave, and caregiver leave).
• Short-term and long-term disability.
• Life insurance.