Senior Provider Education & Outreach Representative (Medicaid)

R-306850
Description
Humana Healthy Horizons in Indiana is seeking a Senior Provider Education & Outreach Representative (Senior Provider Engagement Professional) who will be responsible for managing escalated issues for network providers that participates in Humana Healthy Horizons Medicaid Program for Indiana through provider relationship management, including provider training, education, responding to provider inquiries, and resolving issues or complaints. The Senior Provider Education & Outreach Representative (Senior Provider Engagement Professional) works together to manage work assignments that involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities

• Ensures prompt resolution of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, and referrals.
• Investigates and responds to escalated and complex provider related issues and follow through to resolution.
• Conducts provider outreach and training to support Humana Heathy Horizons network providers in self-service functions - such as eligibility, confirmation, claims submission and payment - by use of available tools.
• Works with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana Healthy Horizon’s, Indiana Medicaid Program.
• Assists other Provider Education & Outreach Representatives in the market to address or resolve issues of significant complexity.
• Creates and/or delivers trainings and educational materials for LTSS and HCBS providers to serve as resources on Humana processes and procedures.
• Works with internal corporate partners to ensure cross-department communication and resolution of provider’s issues.
• Serves as an expert on Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) providers.
• Communicates Humana’s policies and procedures.
• Ensures compliance with Indiana managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes.

Required Qualifications

• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
• Exceptional time management and ability to manage multiple priorities in a fast-paced environment.
• Knowledge of Microsoft Office applications.
• Must be able to travel in the state of Indiana to provider offices and Humana locations.
• Understanding of health insurance claims and ability to analyze data to resolve provider service issues.
• Experience working with LTSS and/or HCBS providers.
• Four (4) or more years of health care or managed care experience working with providers (e.g., provider relations, claims education).
• This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• Must reside in the state of Indiana.
• Proficiency in analyzing, understanding, and communicating complex issues.

Preferred Qualifications

• Experience with service coordination, prior authorizations, and other health plan processes.
• Bachelor’s Degree.
• Experience with Indiana Medicaid.
• Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.

Work At Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information

• Core Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....
• Travel: Up to 15% travel in the state of Indiana to provider offices and Humana locations.
• Workstyle: Remote but may vary due to travel and occasional onsite work at the Humana Healthy Horizons office in Indiana.

Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Social Security Task
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website.
Scheduled Weekly Hours
40