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Job Details

Provider Relations Professional - Behavioral Health

Location
Metairie, LA, United States

Posted on
May 17, 2023

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Profile

Description

Medicaid- Behavior Health Provider Relations (PR) team maintains frontline relationships with network providers. Provider relations team members facilitate transparent and efficient processing of provider administrative matters to ensure reliable provider experiences, supported by timely and accurate payments. To accomplish this, the PR team works directly with providers to guide activities, including onboarding, training and education, complaint resolution and dispute handling, provider portal support, credentialing and re-credentialing issues, and prior authorization process support.

Responsibilities


Provider Relations Responsibilities
Develop and maintain BH provider relationships to optimize provider experience and satisfaction.
Establish consistent, reliable, one-on-one relationships with Providers, serving as the primary point-of-contact.
Ensure resolution of provider inquiries/concerns, including those associated with claims payment, prior authorizations, and referrals
Communicate Humana's policies and procedures and share provider training/orientation materials
Coordinate provider orientation and training sessions
Work with internal corporate partners to ensure cross-department communication and resolution of provider's issues
Work with internal resources and systems to provide the Perfect Experience in all provider interactions with Humana's Medicaid plan
Manage to the state's managed care contractual requirements for provider relations, such as documentation of all provider interactions
Manage provider onboarding and completion of required trainings
Provide or arrange targeted one-on-one training and education opportunities for providers on topics such as claims resolution, prior authorizations and other topics identified by the Provider Relations rep or the provider.


Required Qualifications


2 - 5 years of Health care or managed care with Provider Contracting 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


Bachelor's and/or 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


Additional Information

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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