Provider Education & Outreach Representative (IN Medicaid)

$52,500 - $72,300/Yr

Humana - Indianapolis, IN

Full-time - Entry Level

Hybrid - Indianapolis, IN

Insurance Carriers and Related Activities

About the position

The Provider Education & Outreach Representative at Humana Healthy Horizons in Indiana is responsible for managing relationships with network providers, focusing on onboarding, training, and education. This role aims to ensure a positive provider experience and promote network retention, particularly for Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) providers, as well as Physical Health (PH) and Behavioral Health (BH) providers.

Responsibilities

• Meet regularly with assigned providers to conduct trainings and education, including required annual trainings.
• Serve as the primary relationship manager with LTSS and HCBS providers and/or PH and BH providers.
• Support new assigned providers with onboarding, including orientation sessions.
• Respond to assigned provider questions or inquiries and ensure prompt resolution to provider issues.
• Convene Joint Operating Committee meetings with providers to discuss key operational, clinical, and quality-related topics.

Requirements

• Must reside in Indiana and work at the Humana Healthy Horizons office in downtown Indianapolis at least two to three days per week.
• Must be able to travel up to 15% in the State of Indiana to provider offices and Humana locations.
• 2+ years of health care or managed care experience working with providers.
• Experience working with LTSS and HCBS providers and/or PH and BH providers.
• Experience in a health care administration setting.
• Understanding of claims systems, adjudication, submission processes, coding, and dispute resolution.
• Proficiency in analyzing and communicating complex issues.
• Exceptional time management skills and ability to manage multiple priorities.
• Working knowledge of Microsoft Office applications.

Nice-to-haves

• Bachelor's Degree.
• Experience with Indiana Medicaid and Medicare Advantage guidelines.
• Understanding of managed care contracts, including contract language and reimbursement.
• Comprehensive knowledge of claims systems, adjudication, submission processes, coding, and dispute resolution.

Benefits

• 401k
• Medical
• Dental
• Vision
• Tuition assistance
• Short-term and long-term disability
• Life insurance
• Paid time off
• Company and personal holidays
• Volunteer time off
• Paid parental and caregiver leave