Provider Engagement Professional 2

Become a part of our caring community

The Provider Engagement Professional 2 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.

The Provider Engagement Professional 2 is responsible for day-to-day front line relationship management for network providers in Humana's Healthy Horizons in Oklahoma's Medicaid Plan, including provider onboarding, training, education, responding to provider inquiries, and resolving issues or complaints. This role will support physical and behavioral health providers in their designated region and must be based in Oklahoma. The role will require critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.

Key Role Objectives

• Serve as primary relationship manager with physical and behavioral health 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 trainings and education, including required annual trainings, ensure understanding of Humana policies and procedures, explain Humana systems, etc.
• Support new assigned providers with onboarding, including orientation session(s)
• Respond to assigned provider questions or inquires, and if necessary, ensure prompt resolution to provider issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana's Oklahoma Medicaid plan
• Convene Service Operating Committee meetings with providers, including organizing agendas, materials, and other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics
• Communicate updates on Humana's policies and procedures and Oklahoma's SoonerSelect programmatic updates
• Coordinate regional provider townhalls and/or trainings
• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana's Oklahoma Medicaid plan
• Ensure compliance with Oklahoma's managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes

Use your skills to make an impact

• 2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education)
• Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution
• Must reside in Oklahoma
• Willing and able to travel frequently to providers and Humana locations (daily travel up to 50% of the time)

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• Bachelor's Degree
• Experience with Oklahoma Medicaid
• Experience working with behavioral health providers, facilities and/or FQHCs is strongly desired
• Understanding of provider contracts and credentialing, including contract language and reimbursement