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