Provider Relations Executive SC Medicaid

Profile

Description

The Provider Relations Executive is responsible for network provider training, education, and provider relations including the creation and management of provider and staff training curriculum and content, scheduling external training events, organizing webinars and receiving provider feedback to continuously improve the provider experience and assist providers in managing the care of Humana's members. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Exercises independent judgement and works under minimal supervision.

Responsibilities

Key Role Objectives


In conjunction with the Director of Contracting, assists in provider network development and provider contracting strategies to ensure a sufficient network for meeting the health care needs of Humana's South Carolina Medicaid plan members.
Coordinate communications between Humana's Medicaid Plan and providers. Ensure prompt resolution of provider inquiries or concerns and appropriate education about participation in Humana's South Carolina Medicaid plan.
Development of policies and procedures and provider training/orientation materials.
Facilitate provider training and provider orientation sessions. This will include scheduling and coordinating with internal resources to ensure appropriate representation from Humana's Medicaid Plan management and operations team.
Represent the local market leadership in planning and strategy with internal corporate partners to ensure cross-department alignment and communication.
Work with internal resources to provide the Perfect Experience in all provider interactions (e.g. claims, reimbursement, and provider enrollment/credentialing) with Humana's South Carolina Medicaid plan.
Manage provider relationships for high performance and satisfaction.


Required Qualifications


Bachelor's Degree
6 or more years of progressive experience in managed care operations, including network management and provider relations
Experience working with Medicaid programs
Exceptional relationship management skills
Excellent written and verbal communication skills and experience presenting to varied audiences
Project leadership experience
Thorough understanding of managed care contracts, including contract language and reimbursement
Ability to manage multiple priorities in a fast-paced environment
Knowledge of Microsoft Office applications
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must live within the State of South Carolina


Preferred Qualifications


Master's Degree
Experience with the South Carolina Medicaid MCO contract, including network adequacy requirements and standards for provider relations compliance
Experience with value based contracting


Additional Information

This position will be work at home in South Carolina, however, you will be required to travel to provider offices within the region up to 50% of the time.

The associate must reside in South Carolina.

Scheduled Weekly Hours

40

Company info

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