Note: The job is a remote job and is open to candidates in USA. Humana Inc. is a leading U.S. healthcare company that focuses on delivering care and services to improve health outcomes for individuals and communities. The Provider Engagement Professional 2 is responsible for developing and maintaining relationships with healthcare providers to enhance financial and quality performance within the health plan's network.
Responsibilities
- Develop and grow positive, long-term relationships with physicians, providers and healthcare systems
- Support and improve financial and quality performance within the contracted working relationship with the health plan
- Represent the scope of health plan/provider relationship across areas such 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
- Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
- Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
- Follow established guidelines/procedures
Skills
- Bachelor's Degree
- MUST reside in one of the following counties in FLORIDA- Palm Beach, Martin, St Lucie, Indian River, Okeechobee
- 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
- Planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
- Convert files, merge and reorganize in Adobe
- Experience in Excel with ability to create pivot tables, V-look ups, and create basic formulas; knowledge to work with many individuals at same time without overriding data
- 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.