Humana
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Provider Engagement Professional
role at
Humana
1 day ago Be among the first 25 applicants
This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base Pay Range $59,300.00/yr - $80,900.00/yr
Become a part of our caring community and help us put health first
The Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan. The work assignments are varied and frequently require interpretation and independent determination of appropriate courses of action.
Humana Healthy Horizons in Oklahoma is seeking a Provider Engagement Professional who 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 Relations Representative 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. It requires 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 inquiries, 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
Required Qualifications
Must reside in Oklahoma
Position is field‑based in Oklahoma and requires frequent travel to providers and Humana locations
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
Exceptional relationship management and interpersonal skills
Proficiency in analyzing, understanding, and communicating complex issues
Exceptional time management and ability to manage multiple priorities in a fast‑paced environment
Knowledge of Microsoft Office applications
Preferred Qualifications
Bachelor’s Degree
Experience with Oklahoma Medicaid
Experience working with behavioral health providers, facilities and/or FQHCs is strongly desired
Understanding of managed care contracts, including contract language and reimbursement
Additional Information WAH Internet Statement
To Ensure Home Or Hybrid Home/Office Employees’ Ability To Work Effectively, The Self‑provided Internet Service Of Home Or Hybrid Home/Office Employees Must Meet The Following Criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Driving Statement
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and is expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours 40
Pay Range $59,300 - $80,900 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description Of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, 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 and many other opportunities.
About Us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Seniority level
Entry level
Employment type
Full-time
Job function
Other
Industries
Insurance
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Provider Engagement Professional
role at
Humana
1 day ago Be among the first 25 applicants
This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base Pay Range $59,300.00/yr - $80,900.00/yr
Become a part of our caring community and help us put health first
The Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan. The work assignments are varied and frequently require interpretation and independent determination of appropriate courses of action.
Humana Healthy Horizons in Oklahoma is seeking a Provider Engagement Professional who 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 Relations Representative 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. It requires 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 inquiries, 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
Required Qualifications
Must reside in Oklahoma
Position is field‑based in Oklahoma and requires frequent travel to providers and Humana locations
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
Exceptional relationship management and interpersonal skills
Proficiency in analyzing, understanding, and communicating complex issues
Exceptional time management and ability to manage multiple priorities in a fast‑paced environment
Knowledge of Microsoft Office applications
Preferred Qualifications
Bachelor’s Degree
Experience with Oklahoma Medicaid
Experience working with behavioral health providers, facilities and/or FQHCs is strongly desired
Understanding of managed care contracts, including contract language and reimbursement
Additional Information WAH Internet Statement
To Ensure Home Or Hybrid Home/Office Employees’ Ability To Work Effectively, The Self‑provided Internet Service Of Home Or Hybrid Home/Office Employees Must Meet The Following Criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Driving Statement
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and is expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours 40
Pay Range $59,300 - $80,900 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description Of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, 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 and many other opportunities.
About Us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Seniority level
Entry level
Employment type
Full-time
Job function
Other
Industries
Insurance
Referrals increase your chances of interviewing at Humana by 2x
Sign in to set job alerts for “Professional” roles.
#J-18808-Ljbffr