Provider Engagement Professional 2

Humana Inc.

Job Overview

Location

Remote Oklahoma

Job Type

Full-time

Full Job Description

📋 Description

• Develop and nurture long‑term relationships with physicians, providers, and healthcare systems to support and enhance financial and quality performance within Humana’s Healthy Horizons Oklahoma Medicaid Plan.
• Serve as the primary relationship manager for physical and behavioral health providers, ensuring a positive provider experience and promoting network retention.
• Conduct regular in‑person and virtual meetings with assigned providers to deliver trainings, education, and required annual compliance sessions, covering Humana policies, procedures, and systems.
• Facilitate new provider onboarding, including orientation sessions and credentialing support, to ensure smooth integration into the network.
• Respond promptly to provider inquiries and resolve issues or complaints by coordinating with enterprise business teams (claims payment, prior authorizations, referrals) and educating providers on participation in Humana’s Oklahoma Medicaid plan.
• Convene Service Operating Committee meetings with providers, preparing agendas, materials, and coordinating with clinical and provider engagement staff to discuss operational, clinical, and quality topics.
• Communicate updates on Humana’s policies, procedures, and Oklahoma’s SoonerSelect programmatic changes to keep providers informed and compliant.
• Coordinate regional provider townhalls and training sessions to reinforce best practices and policy changes.
• Work closely with internal resources and systems (claims, reimbursement, provider enrollment) to deliver a seamless provider experience across all interactions.
• Ensure compliance with Oklahoma managed‑care contractual requirements, including timely claims dispute resolution and adherence to contractual language and reimbursement terms.
• Travel frequently (up to 50% of the time) to providers and Humana locations, maintaining a hybrid work model that balances remote office work with on‑site visits.
• Leverage critical thinking and problem‑solving skills to address complex provider issues and improve operational efficiency.
• Maintain a high level of professionalism and confidentiality, protecting member PHI/HIPAA information in all communications and data handling.
• Collaborate with cross‑functional teams to identify and implement process improvements that enhance provider satisfaction and network performance.
• Participate in continuous learning opportunities to stay current on Medicaid regulations, provider relations best practices, and industry trends.
• Demonstrate strong interpersonal skills, fostering trust and open communication with providers and internal stakeholders.
• Uphold Humana’s commitment to whole‑person well‑being by promoting a culture of care and support for both providers and patients.

🎯 Requirements

• 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
• Must reside in Oklahoma and be willing to travel frequently (up to 50% of the time) to providers and Humana locations
• Bachelor’s Degree (preferred)
• Experience with Oklahoma Medicaid and behavioral health providers, facilities, or FQHCs (preferred)
• Strong interpersonal, communication, and problem‑solving skills

🏖️ Benefits

• Medical, dental, and vision coverage
• 401(k) retirement savings plan with company match
• Paid time off, company and personal holidays, paid parental and caregiver leave
• Short‑term and long‑term disability insurance
• Life insurance and additional wellness opportunities

Skills & Technologies

Remote

$59k-80k

Degree Required

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Humana Inc.

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About Humana Inc.

Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.

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