Provider Relations Representative, LTSS/BH
$59,300–$80,900 year
RemoteUnited States or Galax, Virginia, United States
EXPIREDUnited States or Galax, Virginia, United StatesRemoteFull Time$59,300–$80,900 yearBachelors DegreeHEALTHCARELarge
Full TimeBachelors DegreeLargeHEALTHCARE
Job Summary
Manage daily front-line relationship management for LTSS and HCBS providers within Humana's Healthy Horizons in Virginia Medicaid network. Conduct training sessions, host orientation, and resolve inquiries by collaborating with enterprise teams on claims and prior authorizations. Create provider trainings based on feedback and convene regional meetings to discuss operational and quality topics. Ensure compliance with Virginia managed care contractual requirements and coordinate townhalls and conferences.
Required Qualifications
- Must reside in Virginia (SW region includes, Lee, Wise, Washington and Galax)
- Bachelors degree OR 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
- Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
- Demonstrated ability to manage multiple projects and meet deadlines
- Must be based in Virginia
- Must reside in Virginia (SW region includes, Lee, Wise, Washington and Galax)
Desired Qualifications
- Master's Degree
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
- Comprehensive knowledge of Medicare policies, processes and procedures
- Experience with Medicaid electronic visit verification (EVV)
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