Provider Engagement Professional - Network Development and Relations - Dental
Humana
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Posted on Wednesday, August 16, 2023
Description
The Provider Engagement Professional 1 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 Provider Engagement Professional 1 work assignments are often straightforward and of moderate complexity.Responsibilities
The Provider Engagement Professional 1 - Network Development and Relations-Dental works directly with our Provider Network to develop and strengthen relationships. Educating our providers on the value of participating in the Humana Dental Network and creating a mutual professional relationship with those providers, is key to the growth of the Network. The ability to create an “easy to do business with” environment for the providers is a key function of this role.
- Work with DSO & large group partners on credentialing and re-credentialing projects.
- Work with claims unit to identify and assist in claim resolutions for providers on all systems
- Educate Provider Offices on all existing and new products and plans
- Provide support to Provider Offices on all maintenance and service issues
- Assist with member/provider disputes and provide assistance to SIU and G&A
- Assist Provider Offices/Rental Partners with any contract issue.
- Work proactively with offices regarding fee schedule and financial incentive discussions.
- Work with Rental Partners to assure cost saving measures have been met.
- Add/Term locations, associates and products to existing provider relationships
- Provide support with new product roll-outs and assist in re-contracting efforts
- Process terminations of providers
Required Qualifications
- 2+ years of experience with Dental platforms
- Must be Detailed oriented
- Proactive thought leadership/Root Cause problem resolution skills
- Excellent oral and written communication skills
- Ability to multi-task, manage multiple projects, and meet deadlines
- Desire to learn and advance
- Experience with Excel and Outlook
- Customer Care/Service Experience
Preferred Qualifications
- Bachelors Degree
- 3-4 years experience in Health Care industry
- Experience working with MTV, CBIS, QicLink, DPNMS, CRM
Additional Information
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
· At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
· Satellite, cellular and microwave connection can be used only if approved by leadership
· Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
· Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
· Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.