Senior Provider Relations Professional SC Medicaid

Profile

Description

The Senior Provider Relations Professional is responsible for day to day front line network provider relationship management for Humana's South Carolina Medicaid plan through provider contracting, provider training, education, and provider relations. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Exercises independent judgement and works under minimal supervision.

Responsibilities

Key Role Objectives

Develop and maintain provider relationships to optimize provider engagement, performance and satisfaction.

Ensure prompt resolution of provider inquiries or concerns and appropriate education about participation in Humana's South Carolina Medicaid plan.

Communication of Humana's policies and procedures and provider training/orientation materials.

Participate in provider training and provider orientation sessions.

Execute on Humana's South Carolina provider network development strategies to ensure a sufficient network for meeting the health care needs of Humana's South Carolina Medicaid plan members. This will include provider contracting.

Work with internal corporate partners to ensure cross-department communication and resolution of provider's issues.

Work with internal resources to provide the Perfect Experience in all provider interactions (e.g. claims, reimbursement, and provider enrollment/credentialing) with Humana's South Carolina Medicaid plan.

Required Qualifications

Bachelor's Degree

4 or more years of progressive experience in managed care operations and provider relations

Exceptional relationship management skills

Excellent written and verbal communication skills

Proficiency in analyzing, understanding, and communicating complex issues

Thorough understanding of managed care contracts, including contract language and reimbursement

Ability to manage multiple priorities in a fast-paced environment

Knowledge of Microsoft Office applications

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Must reside in South Carolina

Preferred Qualifications

Master's Degree

Experience with the South Carolina Medicaid

Additional Information

This position will be work at home, however, you will be required to travel to provider offices within the South Carolina Market up to 50% of the time.

Associate must reside in South Carolina.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com