Responsible for day-to-day, front-line relationship management for network providers in Humana Healthy Horizons in Virginia Medicaid Plan
Supports provider onboarding, training, education, and inquiry/issue support and resolution
Develops and grows positive, long-term relationships with physicians, providers and healthcare systems
Serves as primary relationship manager with assigned providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention
Meets regularly, both in-person and virtually, with assigned providers to conduct training and education
Responds to assigned provider inquiries and supports prompt issue resolution
Creates provider trainings based on provider feedback, trends in claims or process changes
Educates provider on location and content of all provider facing materials (Orientation, Provider Manual, Newsletter, Program Updates, Etc.)
Convenes regular meetings with providers to discuss key operational, clinical, and quality related topics
Educates on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, Quality resources, and member resources
Communicates updates on Humana's policies and procedures and Cardinal Care programmatic updates
Coordinates periodic regional provider townhalls and/or trainings
Attends Network Meetings/Conferences
Ensures compliance with all Virginia managed care contractual requirements for provider relations

Must reside in the Tidewater Region of Virginia
2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education)
Experience working with physical health providers, facilities, ancillary providers, and/or FQHCs
Experience in provider operations, building strong relationships with provider organizations, financial/contracting arrangements, and/or regulatory requirements
Exceptional relationship management and interpersonal skills
Proficiency in analyzing, understanding, resolving, and communicating complex issues
Exceptional time management and ability to manage multiple priorities in a fast-paced environment
Thorough understanding of managed care contracts, including contract language and reimbursement
Exceptional written and verbal communication skills
Strong presentation and facilitation skills
Knowledge of Microsoft Office applications

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
short-term and long-term disability
life insurance and many other opportunities

Provider Relations Representative – PCP

Key skills