Humana Looking For Senior Provider Engagement Professional – Medicaid Prospective Programs Work at Home at Louisville, KY Full Time

The Senior Provider Engagement Professional 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 Senior Provider Engagement Professional work assignments involve complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Engagement Professional represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, data sharing, connectivity, documentation and coding, operational improvements and other areas as they relate to risk adjustment prospective programs.

Supports effective deployment of programs at the practice level through strategic partnerships with participating practitioners and practice staff while identifying opportunities for prospective program improvement.

Designs practice level prospective program transformation for Humana Wellness Assessments (HWA) through targeted clinical education and approved materials for provider and staff education during meetings.

Educates market provider facing teams to provide education on HWA activity or value based payment opportunities.

Coordinates and performs prospective program performance evaluations through focused studies as required by market.

Investigates gaps in clinical documentation where system variation has impact on issues related to member re-documentation and member conditions.

Based on findings of focused studies, provides follow-up education, practitioner intervention, and measurement as needed to drive quality improvement.

Begins to influence department’s Medicaid prospective program strategy.

Makes decisions regarding technical approach for project components, and work is performed without direction.

Required Qualifications

Bachelor’s Degree in Business Administration, Health Administration, or similar course of study OR

3+ 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, bonus, and value-based payment methodologies

Ability to thrive in a large matrix organization with a complex structure

Demonstrated ability to manage multiple projects and meet deadlines

Must be passionate about contributing to an organization focused on continuously improving provider experiences

Work At Home Requirements: Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work. Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.

COVID Requirements: For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols OR

Provide proof of applicable exemption including any required supporting documentation

Medical, religious, state and (remote-only) work exemptions are available.

Preferred Qualifications

Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance

Comprehensive knowledge of Medicaid/Medicare policies, processes and procedures

Experience with risk adjustment prospective programs

Additional Requirements

Hours: Monday-Friday, 8am to 5pm, 40 hours/week

Scheduled Weekly Hours

40